GW1 - New Hanover Oct-Apr 2017

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC
28429
City or Town State Zip Code
( 910 )-231-6669
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) i
WELL CONSTRUCTION PERMIT# W 0�Q
OTHER ASSOCIATED PERMIT#01 applicable)
3. WELL USE (Check plicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED (.7L7 l AM O PMO
4. WELL LOCATION:
CITY: Li , 1 1 1 n�f(.)( 1 COUNTY Net(/ }
"U 110 , i l ui o C-J-1, DC Q8'z-tq
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge
(check appropriate box)
LATITUDE
LONGITUDE
0 Other
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. WELL OWNER pj�^
OWNER'S NAME Ken 0
STREET ADDRESS 1 1 0 D (G_3 1k
City or Town State
(CtIC)_ 031-666f
Area code - Phone number
6. WELL DETAILS: / p^
a. TOTAL DEPTH: beJ
b. DOES WELL REPLACE EXISTING WELL? ESO NO 0
c. WATER LEVEL Below Top of Casing: r.)cFT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING ISA 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accor ance with 15A NCAC 2C .0118,,
e. YIELD (gpm): D. METHOD OF TESTA ) I'?f""
Zip Code
446879
f: 'DISINFECTION: Type \1 .T 1" l Amount 1. f h
g. WATER ZONES (depth):
From 4 b To 6a From To
From To From To
From To From To
7. CASING: Thickness/
Depth 'Ic�
From 4 1 To Ft
From To l _ Ft.
From To Ft.
Dia,(Eeter
Weight tv Mr riaL
8. GROUT: Depth 2 Material (�Method
From n To i Ft. C� -1 r t
r-.
From 9) To --Dt� Ft. � s-f "'S P NCr
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From To Ft.in in.
From To Ft.in. in.
From - To Ft. in in.
10. SAND/GRAVEL PACK:
Depth
From
From
From
11. DRILLING LOG
From To
0-. \0
Size Material
To Ft.
To Ft.
To Ft.
12. REMARKS:
Formation Description
Sa nc
lav
• i-14.1l4 Au1'• C
nr1 0 9 2n1/
linformstion
Unit
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOROA
15A NCAC 2C. WE ONSTRUCTION STANDARDS, AND THAT A COP
RECORD HAS a}5rJ PROVIDED TO T) WELL OW
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Michael C. Sage
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
RECEIVED/NCDENR/DWR
Submit the original to the4Jivision of Water Q�{alitytwithin 30 days. Attn: Information Mato
'1617 Mail Service Centert_\Raleigh, NC 27699.1617'I Phone No. [phone] ext 568. DC,
T 1 % 2017
Form GW-la
Rev. 3/07
Water Quality Regional
Wilmington
Section
Regional Office

WELL CONSTRUCTION RECORD (GW-11
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (te. UIC, County State, Valiance, etc.)
3. Well Use (check well use):
WP0012741
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipalfPublic
XQResidential Water Supply (single)
Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 9/29/17
5a. Well Location:
Airlie Homes
Recovery
(Groundwater Remediation
OSalinity Barrier
fStormwater Drainage
Subsidence Control
['Tracer
(Other (explain under #21 Remarks)
Well ID#N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
342 Shore Point Drive
Physical Address, City, and Zip
New Hanover
R04400-004-014-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
34 16 27.6 N 77 48 4.3 w
6. Is(are) the well(s)a% Permanent or ®Temporary
7. Is this a repair to an existing well: ®Yea or xONo
If this is a repair, fill out known well construction information and explain the nature of the
repair underi21 remarks section or an the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled.1
9. Total well depth below land surface: 60
For multiple wells list all depths ifdifferent (example- 3@,200' and 2®100')
(ft)
10. Static water level below top of casing: 3 (ft.)
'fleeter level is above casing, use "+"
11. Borehole diameter: 0-26/10" 21P(in )
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
131x Disinfection type: HTH Amount: 30 ©10g
For Internal Use Only:
446797
Print Form
14. WATER ZONES
FROM
TO
DESCRIPTION
fL
R
R
R
15: OUTER CASING (far
m W tiea,ed wens) OR LINER (if ap livable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 r
26 ft
6 in.
SCH40 PVC
16. INNER CASING OR TUBING
(geothermal closed -loop)-
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 fi
40 R
4 in.
SCH40
PVC
37 ft.
47 ffi
2 in-
SCH40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
R
re.
in
ff.
R
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft
40 ff-
Bentonite
Poured
ft.
ft.
R
IL
19. SAND/GRAVEL
PACK
(@'applicable)
FROM
TO
MATERIAL -
EMPLACEMENT METHOD
ft
R
R
R
. 20_ DRILLING
LOG (attach
additional sheetadaeceosary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft
17 R
Sands/clayey sands (orange)
17 ff•
45 R
Weathered orange limestone
45 ft
60 ft
Gray linestone
R
ff.
R
R
ft
ft
ft
21.=HARKS t OCT 6:6 2017
informatitnt Pnlcsn9'- .
DWO/bOC;
22. Certifcatlon:
Signature ofCenified Well Contractor
By signing this form, I hereby cengfy that the well(s) was ere) constructed in accordance
with 154 NCAC 02C .0100 or ISA NCAC 02C .0200 Well Constriction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this fomREDVED9rinE ;j:;. vl of well
construction to the following:
Division of Water Resources, Information rocessing Unit,
1617 Mail Service Center, Ra106TN1271392 J¢/7
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonnwl '4 2n gays, ofcompletionof well
construction to the following: V'U y K ti na i
�/,/ Operations Section
Division of Water Resources, Undergil lit filje giedaticr)(iAiOgram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Suutly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well contraction to the county health department of the county
where constructed.

RESIDENTIAL WELL CONSTRUCTION RECORD tf14 6 3 l 2
North Carolina Department of Environment and Natural Resources- Division of Water Quail
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC 28429
City or Town State
( 910 ).231-6669
Area code- Phone number
2. WELL• INFORMATION:
•
SITE WELL ID #(i( applicable) WELL CONSTRUCTION PERMIT# u'P 9s. \5 C4
OTHER ASSOCIATED PERMIT#Of applicable)
3. WELL USE (Check A plicable Box): Residential Water Supply0
DATE DRILLED
TIME COMPLETED AM 0 MO
4. WELL LOCATION; (� J�
CITY: t )i11, Is,1 1 1 COUNTYlVeLo 00u
13 a klaVahm r 8rL11L,p`/-�,\
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
TOPOGRAPHIC /,s SETTING:
0 Slope 0 Valley d1 N. 0 Ridge 0 Other
(check appropriate box)
LATITUDE
LONGITUDE
Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: o GPS 0 Topographic map
(location of well must be shownon a USGS topo map and
attached to this fonn if not using GPS)
5. OW
NER V 1• t O
OWNER'S'S NAME us
/S•TREET ADDRESS flI 10 (1 tt
W I I Mr1,-Irk`M-e, NC c(
City or Town State ZipCode
O�JSek- a6 C F
Area code - Phone number
8. WELL DETAILS: I�� Er SEP 1
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? lib k ' 'Mitt" 1''+
DWCW
c. WATER LEVEL Below Top of Casing: Ft.
(Use "+" If AboveTopof Casing)
d. TOP OF CASING IS t �-1. FT. Above Land Surface`
`Top of casing termina ed at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118C. ,
e. YIELD (gpm): IUD METHOD OF TESTAt\ 1r }t-
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To 1 From To
From- To- no From .-. To
From To From To
7. CASING: Thickness/
Depth Di meter 1 ht t 'al
From41 To---gO Ft. A 1n
From To FL
__--
From .T To- Ft.- % q l-.10 Pit
8. GROUT�:q. Depth Mattserriiaal.,, n Meth _ r
From lJ' To 3 Ft. &C''l71 11 C. [g(c
From- 3 To- P,O FL
From To Ft.
9. SFromEN [ „pe1,Of-i To__LAU �rlj
__ FFt. r cl.r in.Sloj¢ize in. VL.
From To Ft. in. in.
From To Ft in in.
10..SAND/GRAVEL PACK:
,•r Dagger1 In, Size fevu -LICK
From �j To IC) Ft. � a ����lA 7..LLIi
From To Ft.
From To Ft.
11. DRILLING LOG
From To Formation Description
0 - 36
"3n:- Fn roc-t'Se SAC4
_fin- no 5t-fl( M /
`/o- tan tiMes-lent
�tvitd
iq ROC PC
P fir. PO `crdS'-isle
12. ' MARKS:
2017
:civic Una
Jtho HEREBY CERTI THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, W ONS UCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS PRO DTO EWE NER.
SIGNA U OF F CONTRACTOR DATE
Michael C. Sage
r,�p �I11pN}
PRINTED NAME OF PERsKrict rINENIALI JLsLL
017
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Form GW-la
Water Quality Regional Rev. 3/07
Operations Section
Wilmington Regional Office

Print Form s.
Ni
Ni
WELL CONSTRUCTION RECORD (GW-1)
1. Iv ell Con tractor Information:
John Salmon
Well Contractor Name
3497-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
N/A
list all applicable well coa.Mvefian permits (i.e. (TIC. County. .State, Variance. eta)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cool ing Supply)
Industrial/Commercial
c Irrigation
Non -Water Supply Well:
Monitoring
DMunicipal/Public
Residential Water Supply (single)
DResidentinl Water Supply (shared)
QRecovery
njection Well:
�iAquifer Recharge
Aquifer Storage and Recovery
�I Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
DGroundwater Remediation
Salinity Barrier
�Stormwater Drainage
(Subsidence Control
fTracer
rilOther (explain under421 Remarks)
4. Date Well(s) Completed:7/6/17 Well ID#N/A
5a. Well Location:
Hagood Homes
N/A
Facility/Owner Name Facility IDh (if applicable)
1910 London Lane, Wilmington, NC
Physical Address, City, and Zip
New Hanover
R05706-005-042-000
County Parcel Identification Noe(PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field, one Iaulong is sufficient)
34 1355271 N 77 48525223
6. Is(are) the well(s)j% Permanent or DTemporary
7. Is this a repair to an existing well: I©Yes or x®No
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this fora.
W
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 180
For multiple we/Is list all depths if different (example- 3Crd.200' and 20100')
(ft.)
10. Static water level below top of casing: 45 (ft.)
Ifwater level is above casing, use "-"
11. Borehole diameter: 5 7/8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 60 Method of test: Airlift
HTH
0
13b. Disinfection type: Amount: 3 /o@10g
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap dicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 if-
160 ft
4 1"'
SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO j DIAMETER
THICKNESS
MATERIAL
B.
A.
m.
D.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT' SIZE
THICKNESS
MATERIAL
160 ft
180 fL
2 'm
.010
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
20 ft
Bentonite
Poured
ft.
ft.
rt.
ft.
19..SAND(GRA V EL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT MET HOD
260 ft
280 ft
Coarse
Poured
ft.
H.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color,hardness, saiVrock type, grain size, etc)
0 It.
20 f°
Yellow orange sand
20 ft.
40 ft.
Coarse sand and clay
40 ft-
55 ft.
Clay
55 ft
70 ft
Large limestone white
70 ft.
158 ft
Clay layered with limestone
158 ft.
180 fL
Sandstone
ft.
ft.
21. REMARKS
iJt 182017
Cer Tieafion:s
07/23/17
II Contractor \ Date
y signing this form, I hereby eerily that the well()) was (were) constructed in accordance
with I5A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page toaa,,$$ffrrQy,'., fli R details or well
construction details. You may alsREW1 fdA7a1ty]a°ges if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this fonukl ri123lad7017
ays of completion of well
construction to the following:
Division of Water Resourcw
1617 Mail Service Center
f 1quizto t rief4§14 unit,
Putl Re 1Ze
o
���g�tio�n Reg
24b. For Iniection Wells: In addition no- CRdmg the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this forth within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

PrintForm
WELL CONSTRUCTION RECORD (GW-1)
Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC' Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name 2. Well Construction Permit#: N/-
A
List all applicable well construction permits (i.e. We Colony. Stare. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
QMunicipal/Puhlic
['Residential Water Supply (single)
fResidentiat Water Supply (shared)
['Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 7/25/17
5a. Well Location:
Agnes R. Beane
['Groundwater Remediation
['Salinity Barrier
lStormwater Drainage
['Subsidence Control
['Tracer
("Other (explain under#21 Remarks)
Well m# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
1005 Airlie Road, Wilmington, NC 28403
Physical Address, City, and Zip
New Hanover
R05700-006-041-000
County Parcel Identification NO(PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iadlong is sufficient)
34 12 49.7 N 77 49 10.5
W
6. Is(are) the well(s)aPermanent or JITemporary
7. is this a repair to an existing well: ['Yes or QNo
If this is a repair. fill out known well construction information and explain the nature of the
repair wider i21 remarks .section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells -
drilled: 1
9. Total well depth below land surface: 180
For multiple wells list all depths ifdifferent (example- 3(a7200' and 20100')
(ft.)
10. Static water level below top of casing: 12 (ft.)
If water level is above casing, use
11. Borehole diameter: 0-180/8n (in.)
12. Well construction method: Mud Rotary
(be. auger, rotary, cable, direct push, etc.)
or Internal Use Only
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
it.
R
ft
1S. OUTER CASING (for multi -cased ells) OR LINER (if ap licable).
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 ft
155 ft
6 n
SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft. '
in.
f
ft.
f.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
m.
18: GROUT
FROM
113
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 R•
24 it
Bentonite
Poured
ft.
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
1't.
ft.
ft.
20. DRILLING
LOG (atta
h additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVmck type, grain sire, ele.)
0 ft
45 ft
Sands to sandy clay
45 ft
102 it
Limestone
102 ft
145 it.
Clay/mud rock
145 ft
180 ft
Sandstone
ft.
ft
ft.
ft
...
it.
R.
AUG a 8 2017
21. REMARKS -
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10 gallons
22. C
lion:
Signature of Certified Well Contractor
07/25/17
Date
By .signing this form I hereby certify that the well(s) was (were) constructed hi accordance
with 15A NCAC 02C .0/00 or 15A NC'AC 02C .0200 IVell Consm,ction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this a e to rovide din ..a ite details or well
construction details. You may N I4tE il,.isu In' �essary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this Alwtig) 3@gigs of completion of well
construction to the following:
Division of Water Resp/,I eec q sing Unit,
1617 Mail Service C�P( l nnpp�-1617
ou
246. For Iniection Wells: In WlilfiU@ I{� YfitatocilitSPthe address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Depamnent of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. wsitcontractor Informotion:
ei4 yYr V Mvte
Wel! CoottarriOMINfis
NO WolICanhtli r Cenfwotionntmtbee
aampnnr Nemt
21 Weil Canatraetieo Permit 0:
idl,rygRinshre mid ammirwflm p enbllr /1
3, WO Vet (steak well tat):
Wafer Sopply Well;
Agelcuatnl
y�yGcotht mtai,dithOMg/Cooiln6 `rdlppty)
3indtantlal/CNmnaeie(al
Nowwa ce Supply Well:
:i monitorbtg
1 ado 'di:
1 Aquifer Recline
i Aquittr Storage and Recovery
Aquifdt tog
]Experiments' Technology
(ieaibennal (Closed loop)
, oOieotbamal anon (loll Roo
b. (/1C, rangy: Srale.'Poripmc Val
Difonbipal/Pnblio
()Residential Water Supply (clog%
fResidn(tiol WaletSupy y.(dwed)
For Intetttaj lloe Only:
dt '-'."dam --
dv ft. f` ,cago.7k`�.
ft.
lEsr 't1R:+;�:g�
ibm
kWfnE CAWS
gc
daaM q, I
�ao aCeslft' i<
a•[
•fldrvun acrRcnlediat)on
()Salinity.Bather
•DSaimwattr Online
Dsu6s(dmceCanto!
Orment
lt' + t aaniain undo
4, Date WNY(s) Completed: t j—p Wen' MI
Se, Wed tansdna:
a&'-' ria
Fsatty/t Nome ntw /hdlily ti#sQrarpamWe)
St w//a
ith Addraffi,(sly,todaat i net"
Catty Ponta AdoniHwdteNr (PRO
5b. Latlbrda aed ioappede in degreed/aluuteshecaeda or dadmal dedeetin
(!1•web geld, one (aOtonglasutfielent).
34 0 //. iD7! N, 077 is 54-3. Czar W
d. Warn) the wctl(0)EIPrxemnent or [Temporary
7-Iethis a repairto nn erbtlaRwd;: OVeaor DAIS
///his Is a rupuir..%gf out bow* well waAntdlat lo/am,bplkn and wife, dm hang es
repot w,dto $21 minutia Naha w co the lerttordorAnn,
& For Ceoprobe)DYl or Omer -Loop C•aoibmnai Welb. having the salt
a onsbnetion.oply I SW-1 is umlcl. Mato "MALNUMRi I(damnns
drilled•
•
9. TMeI well *pd. Moir NO aarRec: (0.)
rormr4llple welts Irnoddepas lt4 ,'cw (cramp-3®e0o'dad 2rl0Nl')
10.Sadeeager Ind bolo* top ofWag: /L- S (p(.)
/fwater htn/t•Sore t:umlagee 'tr-
1.I. $Orebnie dOmet _,,,•£ . (in.)
12. WO etmetruedea matted:
(ia. Amur, ARans cable, dfrt t posh, etc.)
FOR WATER SUPPLY WELLS Na1S,
13e. Weld elan) Mound oe mat:
13b. PRinfecdoa type: Amonnt
le.
Of a,
mN'vl, ,
ire�
smetti xo ... i—� sethste
h n.
O h 3•e �L tom' (!" T Zest,
.t
aa. Cordf attom \
a
,1
, of0502fe4 107
Iv
By agplAgthiybrw, 1 4 lfy.11wr Me mare) woe Overt) cwasnlad in maw
4Na 154
MMCd2C.v/n • mtlehet2ertsm wtd f�,aamwkin &Yakima:& and
tHPy 4/A• k1rNIT) al+P lrt Pn pravldes felae weer ntnwr:
a3. Site dlagroat oraddit)ood well deans:
Yoe may use the back ar this psdo W proaido adJ)tioaal wail silt dtialls m
• onsEnjCiandaeils. You may also.t6adt additional sips tfrusean.
,WBMfrTAL it4STR1vcriora
BI
Zitardtonmtheofi�lijo�w®griaag�r,•,#alqtoHWee y ea 3a lots of completion of
Otr
I16 7 WMAIBe •jtb QEp0. high, NC 27fi99.ldi7 nit:
2eb, For lastanee WelIv In aSiitcinn to satdmg ate form m elm ekldra is
aoshiaaiontonw `if •j l,!y Ke onal`ldim 3 edays tW eamplmwn M'
•ns Section
Division ohilaiFtlibi%alskl(inpd Injection Coon* Prograe
snit ape Service Carfare Raleigh, NC 27001-I436
son Far Wader Snob, a kniceaoe Wan. In Sabin to sending the ton
We address(at) Soper also submit ono *Opy of this tool within 30 day
completion of nell mnsauctium to rho away bath dcpmanegt of the co
what no dueod
,,,, 44.14-4- 221?
•
fl7

Aqua WeII DriilOng
1706 Kennedy Road
910-395-1987- fax [phone] aquawelldrllling0ahellsouth.net
fax
N.C. Ground Water FROM: Goya:nes—Aqua Well Drilling
FAN: 919-807.649E PAGES: 5
PRONE: 919.3074301 DATE: 84-17
RE: Well Records CO
Urgent � For Review
Comments 5 pages Includes
❑ Please Comment ❑ Please Reply ❑ Please Recycle

WELL CONSTAUCTnON RECORD IOW-i2
1. Wen Contractor informaten:
6.41 �inlxS
will Cbmram
NC WeIICrntremm Cerumwatontive0at
�4 iSi aa.�l t,h to ✓( CO f¢i U , .A3 T
Company Name
2.141 Construed:in Permit N:
listallo;pligable WO ,amwin 00 pen»llr (l.r. (11C.. t7i.a &s patrons. rte.)
3. Wed We (cheek well use):
Water Supply Weil:
QAgrieultaml DMunicipellpablit:
• a ahmfnai (ffeafiog,Yh,ofmg Supply) DRosidendY %ter Supply (sbtgia)
m• IndduselaWCommercial Q Itesidtatdal Water Supply (shared}
Nos-WaterSupot, Well:
®adenThotiog fResovery
bsjauoi, WWI:
QAgtUlbr Recberge
©Aquifer Storage and Recovery
Aquifer Tim
0:perimsmt l TeehaoI y
QOsddwrmal (Closed Loop)
.�ifeotiennal(HaMINCool(ugReturn) fOdher(oaplab wider NV Renato)
e. Date Wall(a) Completed: 7! I s el • Well iep
5a. Wed laeudop:
C1Ay fan GSC,f
9Mh' erNaroa %mintyJDI(iFatplMkk)
94-MP Fens possaa Ss DR i0) IAc NC
Physical AdNneta tad' tip are t)g
{ For Intcmal•Uae Only:
445809
4
Ig tit
TO
R
Chat. 3as
R.3 &14; Na
ft.
MAmf.l rnl
$A ea
Ia.
o if ID
MA VAI.
to
1
Dorowtdwatcr Remediedon
©Sarin ty Barter
OStinnwaterDrainage
®Subsidence Control
QT ee
# nna fo A-aau d
Corny Parcel Ininna tan No. (PtN)
Sb.iadinde and Io*udc in degraafmt Ise aewnds or dolma! degrees:
trfwc9 field. one laWuog b stores*
2a" ,/tt tls N o74 4N1. cgs(
6.Is(ore)the wcd(al kermaneut or QTemporary
7.da Ibis a roper to an axiating wdi: Dyes or Wr o
(Poloaarepaerjlnrravownwelfeteartaalwrel0taiiriortwteapinmSJ €JUnViae
repalrtw,br ill/ nmarboavwtw, ,r eta dtvewd•ofmiefirnn
8. For
r Ocidad-1.0pGaotbesmal
die sante
constmd(ioaonly10W igu d,InddicateTOTALNiUMBRofwelb
drilled.
9. Told well depth below bad surhar N b r
lraraS culls bnall
pt deMaa tfdijerml
ttStadewater &re1belowtop ofaaftgo l
ffwafr evelisadewe 'Wary a re M•^
1I. Borebofe Camera: G
12. Well top*fljc oo method:
(Le. savor pss cable, drip nioh,«G)
On.1
17.
MOM
3e n.J Yet
0 POW
/
:.PROM
entat
0
ft. l a
R
yo
ta.
LOT
O10
MAfYarMt�..�._ sstraAcnaan.Ma ...
ff.
11.
nMVEACLMINTMg7Nnli
le.
2131
22. Cori:Seadon:
a ai—M�Mm of Bed tv}j(eo0namee I �/�•��
CV1 t7era
aY+'$aing r fanr, 1000 brae Biro, &timed,ens elvere) eatufne rd M went
Wilt lid COTC .010er ISA NCAC ele.d2(0 WWI Ceartnwtaw Senator wad
ratyof kart eoreaayseerrnaledeaO &owner.
23. Sim dlagr6W ornddhfidhal will details:
You cagy use the book et this Page mpmvide addidaad well sit details us
conshudibnMails. You stay also. attach additienel•pagaifnnesasary,
jtrSMIT.rAL ifignurnojyg
emMpro• l�2ad'aad3�ma1 (ft4 20. F"r All t Submit this Conn within 30 days of coniplei on of
cohstn(dion m the tadowing;
CAC When of Water ReseasseatRkmadon Processing wt.
RECEIVED/NCDENR
AftfallSarirkeCe"mr,Raletge,Nrxvs99-Idt7
24b. j)orinienton WEII); to addition. to sending the Font to the addren h
abnwc, also submit ono copy of this than witihia 30 days of completion of
A U G ??1 ern? the 01lowlag;
Divl�sioeof WOW Reaouraa, Uadee®wad injection Conwol Pngyad
1636 Mail Sctvice Center, $afeigb, NC 396994636
: In addition to aendksg the the
.lxw& disc suamh ono copy of this Awns within 30 day
GO mnswatiun (o this County health dcpasonout of the co
FOR WATER SIMPLY WELLS ONLY:
13e. Yield (gym/
13b. Desnteedao type Mauna
Metodoftc Mat
Waterpar
Wilm�ingty

'WELL CONSTRUCTION RECORD (GW.1I
I. Well Contractor Inform:Mont
Goa I tam.,
Well Carat Name
anti
NC w.nConn„oremiftadon Number
�0...,1 Load. d. Art.tt.,��
Compmy Mum
2. Well Construction Permit 0:
tstalloppleable wdi ow.,vwtkn pamhto r.e, t/J Crmmy. Stm. VMnmr, oh)
3. Well Use (cheek well ote):
Water Supply Welk
Iftgdeldtural ❑Munkipai/Pubge
]Geothermal (Hearing/Cooling Supply) oltaidemial Water Supply (single)
]lnduslriavcommereiai QRaidendal Water Supply (spared)
For Internal Use Only:
445808
3A WA713R•
roam 1�
Sae.
4se'
ft
n
Cutest, Sedr.le�
:nt6pSrr6RCuLSRrGuniamimetwea :LCUIIr
noon To MAMai'tn CNN Moird.R N,
• ItDOER '.CASINGAR'T INCBpa 1 'a�)l•rc�,Aa '; •1•;,';••,.:,
rnom ft.TO
1,1045TdR
Te ATBRII Rle.
R ft.
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Redbalge
jAquifbr Storage and Recovery
OAquifer Test
]Experimental Technology
riatodtamtl (Clod Loop)
fGeothen hall (Heating/Cooling Return)
®Recovery
OGroundwakrRemedied=
DSaiinity Bartle!
®Skrmwater Drainage
DSubsidmee Control
Qtte.rAr
fOther(explain lmderial Remarks)
4. Date Wdl(s) Completed: %—a.. +t 7 Web IDp
S. WeII Leaden:
5.a ..pt. .ta
greilityrOwoerSlame heftily ran (if applicable)
-%- s nt owe D3file DO- W:I0 PC
Physical Adores. City, end Zip a rue.
mt.) ja ...re
Comity PasS idaeedewdun No. (MN)
Sb. Latitede sad longitude is degrcer/mfnuom/swconda or decimal dooms:
Orwell Geld, one tattlong ie sellden0
Cog df'/3. 404w N 'M1 .s5M3 • W
6. Mare) the well(d)OPermanent or f Temuoraty
7. is this a repair to an existing well; ®Yes or ©No
(AAleisa repo4, fie othknown well connmenon htforrrietlen ardexplaM the nawt(the
repair whin 121 nook o Swaim or en shake r efMOAnn.
S. For Geopra: WAFT or Closed -Loop Geothermal Well, baying the same
oonsuueio; eoly 1 OW I is needed. Indicate TOTAL NUMBER of omlls
drilled:
9. Total well depth below Mad surface: dt r
Farmvalple wear the alldept$r itdl�oem (example. 3t200'aM2®00r1
10. Stadewater level below top of easing: /A
(iWGtnr k ei is ,haveew ogg we "M"
C. d
I1. Borehole diameter. (fa.)
12. Well construction method;
(i e, argef nNen cable. Smelled, eta.)
lam
$e 14
n.
To mums
err"' l in,
is
TO MA'i'nWAl. POTAZa11QNTZOTIONnahMOUNT
C e r7e 6t /' F i' 7�s��o
R R
R R
IetwetltllliAl.,.F.; r„,�:. r::a•:;: q. • "'"J'7c::y::
M TO. 1MATaRYk xMrMCaan¢Nf.atSMdn
IL 1/
eeconsitsvers oaft. Nt
"reels rre aNhnG Metqg
r+' �rdrj.
PROM
n:
TO
e.
n.
ra
to.
Oft
R
R
a
re.
R
dy Sing eh Aso !•Aefrty een(d' Nat the wett(s) won (were) honntracaedin aceoatwe
wttu ISA CO2C.0100 orISA NCAC 0217 .2200 wescoanecwal Wsakrrtt and Soa
Logy d tkk record Mr Leh provided to Mewl! none!.
23. Site diagram or additional well defile
You may use the back of this page to provide additional well site details or well
coosouttion details You may alto Mach additional pages if neassory,
SUBMITTAr.1NSTRUCTIONS
(0.) 24a. PM AS We tat Submit this fonn within 30 days of completion of well
eonsarudion to the tbilowt:g:
REWED/NCDESSMULDWa Ralureea,mtormationProcessing MIL
1617 Mail Service Center, Weigh: NC 27699-1617
A U G � u0u Wq))g: In addition to ending the km tothe address io 2aa
v nu: one copy of this toms.witbin 30 days of completion of web
construction to the following:
tarQuaMilk/RiottaterReohrces,UndergroundInjectionControlProgram,
Wll Dper,lions Sec(io }}SS4466 Mail Service Center, Rakish, NC 27699-1636
mingtO,fetr w t i nnlv h. Inieedon Wdtg: In addition to sending the Soma to
die addr s(es) above, Mao submit one copy of this fbm within 30 days of
completion of web construction to the county health department of the county
whop twnfm tied
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (wm) Method of teat:
131% DMinfteuoo type Amount:

Aqua Well Drilling
1706 Kennedy Road
910395-1987 - fax [phone] [e-mail]
fax
To: N.C. Ground Water FROM: GaryJones-Aque Well Drilling
FAX: [phone]e PAGES: 5
PHONE: [phone] - DATE: 8-8-17
RE: Well Records CC:
El Urgent El For Review 111 Please Comment ❑ Please Reply Please Recycle
Comments: 5 pages Includes

6, ls(pre) the wed(a)lafte17a■neet or f Tagpdrary
7.es Ws it repair to aoeatalreegwalk Ores orIONo
/mu is repair, fill wit Mown well'mArnrdlan Nfenriiakin mrdexplo ne the nature oft*
repair soar a2J neaerb molar Wan Se tadtoptedfAJnn,
8. Per OeoprobeMPT or (:ldsd-laop Geothermal Wens having dill s9ene
constmcfoa. may 10Wd is nodal, Indicant TOTAL NUMA3P,R orate%
drilled.
9. Total wdl depth below badaartcet Al b
IrenW(lpfe Net SWa#depths tfdi[prant(
ill SiScwater revel below top olniag: l?
/fwa srlevel is *we anew ma "'4"
II. Borehole diameter: Go
12. Well construcWw method:
(i.e. austral p. carob, deco, push. cc,)
WELL CONSTRUCTION RECORD (GW-I)
1. Well Contractor Information:
v&•x,y Tn Y
'Well Corns* rbake
NC Well Coatroom Codification Numb e
tt t.fl b12.!J,Np
Compoay Name t
2, wail Caruauedoa Permlt#•
ljstall eppl.ecMe Wag maraaw(Mwpeembe /Lr. (!)C Cow* &a Yeawwr, e&y
a Well Dee (Meek well toe):
Water$lrp$yWell:
AgricuRma)
peahoemud fifednstooung Supply)
IndusiSlCOmmercial
Non -Wain Supply Well:
Monitoll
Ae)erolion Well:
Aquifer RlcilWfge
Aquifer Storage and Recovery
Aquifer Test
I perimmest Ceehaology
Geddarmal (Cbsod Lcop)
(laorhetmat (Wallop/Cooling Roam)
Omuniaipalamblia
()Residential Water Supply (single)
OReside*Hal Water Supply (shared)
CI
OOroondwator Remdialhm
()Salinity Barrier
OStonnwater Drainage
®Subsidence Control
Mother (expWn under MI Remarks'
4.Date Wallis) Completed: 7!/rrf Well1W
Be. WWI Loeadom:
�►y #iw G' Se,f I
IMAM or Musa
s�('a./4. Foef.
Wog Adam, ap, end'7jp
alheemar
(:ewniy
[For lEcmalU4e4i5;30 7
Want
2(SAEs_
4
It.
R.
are a CASING ffer
'jet R.
TO
3ek
acAMal,f 'rll
in.
Ym
Mnvaaur
ZO
ft.
D.
at
LAw(ACCMWN1
a(
rt.
to
n O.
(r.
radnty IDD Ofandamnle)
W bite a IAa sitarid,
$ R.
Twee ldmdgwion No. CNN)
Sb Latatnde end Wade b degeissiminutesisecads Or dedma) dogma:
cif WI gold. ono lellwgis arming)
2a e' !Ye rii N Cite' 9/. 43Y'
R. th
Skit
22. Ce ttfeadom
cicit pia!?
'ta
Virux
of lied non Oqa
Sy age' r AA1INN* bet&& rho, de: fait (6jtem netee4 ev ecoed m Atop
WO/JA C07CA10ar1SA Net OIC,d200WWI CmWeeraar5'knedrrekend
etionfr*rtnmrdam bra eel.
23. Sibs dWWram or arida/nal well detail:
You may use the back of dtis page to•pmvide additional well site details OPconstuctibn demik You May dso.aaathadditional papa ifneeeasey,.
4UeMfffAf, nsai ienoNs
momnplw 3Q)Jap•em12�1nn1 ai. 24a. for MI Welt Submit this Dml within 30 doss of complet
tonsby)Wiomto Wet*ae/,
(fall DttjWoe of "'mar` RAPa11oo processing Ott
l6l? Mall•Sonte Center, Wlefgbe NC 270,4417
29A haRDSIDS6 IS add sending the m to the address Ir
above, also submit one uof%hj teem within 30 days of completion of
eousbuaion to the following
Division OWW"
MA WATER 31Rtpl,Y W(t113 ONLY:
13e. Meld (gum) Melted of test:
13b. Dldaftedao Who Amounts
of
* . �a. rid ISSUE Control lrregroo
F.qaj Nigh, NC 29699•td36
2de. for Waoer. Sneak & io i I jigie In addition to seeding the rot
din address*, ehnve. Also submit ono copy of this Auto wlhbie 30 day
completion of won eammucgme to rho Monty health devotions of the co
who.. sw ttnrnna

WELL CONSTRUCTION RECORD (GWd1
1. Weil Contractor Information:
elf, `...,
Well Conga;
sa(99
NC WelICownolrrCenintaeon Number
�TAseu1 t�+.t•
Compoy Nrmc
2. Well Construction Perrot 0: n
daveireppLra2fe nil cwpnmarlan i/uMlils p,& UK, Ceano; Seat, Variants!. no)
3. Web Uea (cheek wet use);
Weer Supply Well:
©Agrisabard f Munioipal/public
OGeothennal (Heatiog/Cooling Supply) °Residential Water Supply (single)
QIndlRtn'avcammereiel f Residential Water Supply (abated)
Saris/dim
Not; Water Supply Well:
°Monitoring
Injection Wdl:
°Aquifer Recharge
°Aquifer Stomp and Recovery
©AneiferTcet
JExperimental 78olrn.lo&v
°Geotheimal (Closed loop) ahem
7loeothenaal GleatinaOCcolinR Return) f otbcr (explain under #21 Remmkd)
4. Date Wdl(a) Completed: ti J- .J e) Well of
IFor internal Use Only:
445806
WA1IRZAINES,,
non TO i» CdIPnO$ s�
�a (1. Srst ester SAAA
« R
1s 01m= C4SINNGiferr
PROM TO
a-1 a To tit.
than
AMITER
2.
L'
tmdwN
bb).
MATERIAL
is
MATERIAL
a
17
3e
R.
TD
a/'S.
R
a
DIAMLRR
t
1m
tar
TS W
TECKN
e0 490
MMUTAL
1 eL
O it'AO
R
R
rtS
.CRICUIT MRTDOD a AMOUNT
RI (L
n
TO
R.
MATERi1
RMMACEMnlnxtnton
Sa. Well Location:
ln3Recoaeir
DGeRmdwata Remedistioa
°Salinity baffler
QStonmwater Drainage
°Subsidence Comet
5e.a pP.ct
Facility/Own, acne Peoilitr EntgrRyliesbte)
a-1l.a r2reOat DIE"
fbyskal Address, Coy, wig Zip
Missal Macao ere
County Paid Idenddaatu„ NA. (PIN)
Sb. Latina and !untlltd ndd�ner/mNuRs/aceoDdt or decimal depress:
Owen gel one lateen
oak ° /3, Virg N &)) . 53; 3 ' W
6.bare) the weg(s)g/Permangnt or °Temporary
7. Is this a teptrto an existing well: ©Yes or ©No
thirty a repar.Niouiknnwn well conennPoa WoMiaton alds:Wlahs the aasanafthe
repafrwdw VI Amok! osalon wan the book ofrhlrlanrr.
S. For Geoprobe)Dfff or Closed -Loop Geothermal Wells having the same
construedow only 1 OW4 is needad. Indicate TOTAL NUMBER of wens
drilled:
net tA.r_. Lea uw
a re
ft.I
2a:11111ELIND',sos a
PROM
n.
ft.
.RWMeYronegremnset. red)
ft
m
ff.
ft.
R
(L
RR
ft.
4R
9. Total well depth below Rod darface: d7 r (fL)
rarmaafple wilt list all Of* g enn (example. sdipos' and2@ipp)
10.Sutieinter kve)kiwi top ofeasing: /a (1L)
ffwamr fever is apwa casing use
U. Borehole diameter:. C. d
Om)
12. Web ronswoedoo method;
(i,e, eas veawe, direct aunt eel
FOR WATER SUPPLY WELLS ONLY:
Da. Yield (pm) Idetbod duet:
13b. Disinfection type: Amount:
dy AVM rh : firm. ' .: •y eetpq that die wed($) war (wend teetmcredin ueeordaar'e
weir/SA C 02C.0/00ar IS.a NetCO2C .0200 PNICoannNapp wane and that a
amnia* record has Sass nvyadro *well water.
23. She diagram or additional well details:
You may use the back of this page to pmvide additional well site details or web
commotion details. You may alto altaciodditiwtd pages if necessary,
gUBMOYAL INSTRUCTIONS
24*. for Ali Wells: plI(j[ � of completion of web
eoosnud?antothe &bo =��nvuerlR/
Ohitien OrWater Resource, :Bout anion Frueesyeg (lait.
1617Mail Sethi"? Rsir2Rhr14C 27699-1617
24b Tor Injection Wejla: In addition to sending the films to the address io 24e
above, oho submit Out copy of this foe) within 30 says of (=pktion 0f well
constmctiontothe fbilowin4Yater quality Regional
Division ofWater Denim
Operat"onsSe -ttir _C�.AZ• B7oControl Program,
en,
mt. For Water Suaaw & IPlethora Well,; In addition to sending the Darns to
the addims(es) above, also submit one copy of this firm within 30 days of
completion of well consWd ion to Oro county haft department of the county
wives ...nemerpd

WELL CONSTRUCTION RECORD (GW-D
1. Well Contractor Information:
Bobby Allred
Well Contractor Name
2610—A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit k:
List all applicable well construction permits (l.e. WC. County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply) °Residential Water Supply (single)
Industrial/Commercial °Residential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge °Groundwater Remediation
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 7/2016
5a. Well Location:.
Cape Fear PUA
Facility/Owner Name
°Recovery
°Salinity Barrier
E
E
r
235 Government Center Dr,
Physical Address, City, and Zip
New Hanover
County
5b. Latitude and longitude in degrees/minty
(if well field, one IaMong is sufficient)
34.22.327
--PLLOLISL(tf'
i"'W t-CL.LL°O 1a' t LA--1` tc t
6. ls(are) the well(s)_Permanent or DTemporary
7. Is this a repair to an existing well: x®Yes or DNo
!phis is a repair, fill out known well constntctian information and explain the nature of the
repair under n21 remarks section or on the back of this firm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 193
For multiple wells list all depths If different (example- Sea 200' and 2©100')
10. Static water level below top of casing: 21
If waterlevel is above casing use "+"
11. Borehole diameter: 19 (in.)
Rotary
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only:
445V45
14: WATER ZONES
FROM
TO
DESCRIPTION
150 ff.
195 ft•
Limestone
ft.
ft.
15, OUTER
CASING (for
multi -eased wells) OR LINER (if a livable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 ft.
150 ft•
24 in.
.375 �304 SS
16. INNER CASING. OR TUBING (geothermal elosed-loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
148 fit.
16 in.
.375
304 SS
188 ft•
193 ft•
14 i"
.375
304 SS
17. SCREEN ,...
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
148 ft•
188 ft•
14 i"
.030
304 SS
B.
fL
in.
IL GROUT .. , ..
FROM
TO I MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
150 f •
cement
tremmie
0 ft•
50 It.
cement
tremmie
ft.
ft.
19.'SAND/GRAVEL PACK (if applicable)
FROM TO- I MATERIAL
EMPLACEMENT METHOD
silibeads
tremmie
p�,/,y
jC r additional sheets if necessary)
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
AUG 11
2017
^ - - , ram,
r•,i=•_
in hole and rained
4-h 5Gt een 4 Ca5tr s
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 700 Method of test: Pump
13b. Disinfection type: Chlorine Amount: 5 gallons
8/7/2017
Signature o$rtified Well Contractor•Date
By signing this, form, l hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0/00 or /5A NCACI 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or ad You
You may use the back MN
d[+ I� diftM al well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRU TI 21 2017
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following.
Water Quality Regional
Division of Wateer I1 6ii1tg3SISBAtMiDion Processing Unit,
1617 MmMiii1iagtrhalag101140027699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WALL CONSTRUCTION RECORD
Titf,-room um h uod €rr Us* sl:mttipFx+udIs
1. %Nell. Contemn* lflhrrnradntit
Brian Ewing
wit t''MmoST N.mk
9240B_=�
NE Well lupin i r( tiiiutanl 1Vaatn
SAEDACCO Inc
#eheah. well Uner;
Sitppty'-Willa
iltltrinli
lmrnYl Olvallnei'Coolinc Supply
1 IIndusleittleCon anental
❑irripinnn
share Water Sifppty'ft5'ddb
munnaG
Injection Weill
O Aquifer Ree=llitor
DAIIMIbr,Zanragc atad Ri n ertr
D hgnitcr TCSt
121Bmentn1Mnl TWIlan1aps
OCittiOrkmtaF at lased Loapt
OCsatitenfml t tlsuti Cruotfnd Renato
-4. Date,
rAttialcApilliPub IC
I1R3sidenttitk Water Stirlen tSiI g'lel
I tBOid ntkfd Wirer fiupppw. 'diu ti
n
4'tfMOMMf n.uer Ruwatti;it inn
I tsHdinita Evict
El$111rmwaier Dnakn,,'n
EIStdaFirtunic rAstt it
Crimea
Dtatlter lesptmn undet a2-1 Renatiicl)
'et1I4Y Ctuuplekrdt 6-29-17 wta fD4MW-4
Sit, Wd1localism
Vertex Railcar Corporation
Surlily On nu eons
202 Raleigh Street, Wilmington,
New Hanover
Cooly ..,_..,,....,...,
Fs-Y61+' q}9 pi'appficahIT
NC, 28412
Flu SuS
PROM I to
ft,
7man flirt,
f.
rL,ia LNNfRC.1.41Nt tNt RBN
,FROST: j`_4fAt
1. 11, is
adm.t to aid nip y31f aARKB
bentonite seal from .5 to 1
I° INN 1,4mutranirri NO 011N,i
$h. Lmlltafteand Lung tutlr lu IIITI CNtwirtnIt.akrcllntlatrn dgdmitl tpatlr'n
nitwit fJd; nor ton* { iidtitkW)
6. Is Wet, Iticntllt+in $IFrrth mint ur DTitninn•I
7,it this a. repair to an eunting*el: Jter or &Na
yea) It xayaub. 8@. ck uouipi, elerdy1,04Uvi.mrc, i or.ima! krirs”
rr 11wok. CI fp niurkrivans': ar has{ opuic &sm..
A %waiter atnelb lwnsttmtied 1
Fwt stste;ste aoit
!n y ir-o+,ka Mwith
.f Af t
i f 41 Yf1IT.u,
9'rind well depth Rehm land ytrtart 15
r lit iliMeS WI'tir lit 1 ,rr,:1.T fitrp,n ,. t.rgy
10. Stacie water level below top of easing;
Reedit* dpameter, 8
12, Well construction owthed: BORED
+1 c offerer i nllat, eagle, dI_.ecl lash aM1C f
.001
filter sand
,lOnUFTIONiokr, hefts,
sand moist to wet
15
sch 90
atareutal. '
pvc
R 0H%Nrtin,k AMOT1,yt'
k emm:Rrwtl.t)e.t4.1
22. t cnlfiesttnn:
Brian Ewing_
aldtuatr.-urC-.narvd lY e4ltnintnnitr
tr,-ayttn,. Hu !Ativ_ r n)r. rr4rin .Irl�
WW1 .!CI WM t!,`t, ..v? of 1 P:I. ,'yF't fl a 170 Reif I
y,'o f/u r.gtn has r r, or FAS:d J.Ss I u' ir1IW1.
to df WAIT' -sir afldilttlnal welt detail!;
nnW use the back of etils pllpa la ptevadr!Kith rnatal well see detain, to aelt
ntcioti deet:iite Vet muy aihsi Meek additional pa tpi s kf ate re
7/9/2017 ._
trans
V.• I
i.I 41. 11 15 .1AItt 11II1y
suiteit FCso,IN.'Spt! 'iltllS,
il�i,,, °,ti }nr en W cienet: S4hnet shh ['non Wi1I1 rt in day; of c,molentat pP arch
t .#lu.lN k SMi$nt[tmnt[r t:r CcrviinW7ru;:
lin hian or sing taii.
11,17 MOB Service Comex. Raleigh. N 14 617.
_a 1.246. EntjainutoBjESOYEM. [ a ctiat to san tliitp the Emu 10 [Itc;tddress nt
pia abate. tdse sabthII ,1 tuipy el Jirut1 t4it@Q1t drags of unuplm[liut of well
kntusingtNB ttt [Ito imtlifa1II .
FOR W,*4IER SCFPL4SITU 4 ON
lda. Vitld iupair ---
lib. 1bi1nfet'fbtn twin
i'trtluid of fevh
_... Amunnt _
OF9tinn Uri/tuber1kl4 wr
1tiJfi Malt Soria
d��D__i��n�IftCan
f��ni'th>lri.Ffl:
zk. or waterwa It i to k7Al! 4INiRegional Office
.k1su subntF um. of this frtrni i. iban iil d.'r, ntcomp101,41. f
well cauwu rion to the county health depnnns<a t of the moray it
munteiCted.
afl
Pool OW -I
latch F]Inaout Normal( of
lup,:t l inn ti.aur t'raiouttts - l.an Aim W..IRA Smote -cm
n4't ISht:Ytil,u el

WELL. CONSTRUCTION RECORD
i91 1 hlnil:;le1 be alF:.d CST 51111dr sr nlniti➢k w .bIs
Wt11.0nttrattur Intnrunllnlc
Brian Ewing
ell 'L'rramnurn uw
NC' Well t_w,mnC1LL i'.:rtwlulaoe rnmlder
SAEDACCO Inc.
t'usnoN. Noce
1. Well thtnstricillon Permit 81
allrt$ ncisdrair fO rrrvie,.l'rrCn,0;,,: ,rvCe. 4sivms•: infEeprp.. mr+
3. Wed tw telex* well trek
W'atnrSarply Wi0IttlAdnentmintl
r iCeeithenvett lficalinglfic hnh Sp
GI ItulusnidfC(enniaerciul
ottrigobiee
Non-Vette Snittltly II:
®hlgmtonne
teleellitn WtI
f1Aquifcr Redwine
CJAgincur 'flange ;Pet Ra.'r,'rE' cry
Cl'Aguifer-l't5I
❑pSpet tnemnl lozirnetugT
126coil emwt;Closed Loop;
OCroilter edIlleanoxtnolIer! Ru
. hate S►'rRitil C[aniplclnh 6-29-17
Sit 141441 Logan;
Vertex Railcar Corporation
T:aada+;Cncrer`:war'T.
Llni tnlcipX kTI
inifecfdeniiet Water Suptnc (sinete)
I lik stdentdtt abater Supply!Maaad?
OttccavcrE
Dein6rnalwmerlieu lotion
r iti0hnlly Namur
081eneworcr 13nOrtedpF
❑fkrehcidencc f.'niGml
Detlurt inviter; odor 42:t Rrnwrk:3)
W'elf i111f-3
R•Q,1sl I7 x rIt 1tt1,1-i-ahlr5
202 Raleigh Street, Wilmington, NC, 28412
New Hanover
fir. Lulitude and. Luwuitudr in rkTyvma,'inion
ill brill richt ma I 1 rote. In nln8ckult
•
allavx:o ieNiecc. tin. lip
ry ne8 I($.n@RalnutrlVyl. 13'eii~��
iktarunrlranr ikuimul rfc✓Srwtts:
li. le ;are) the weltst: 2A:raiment ut OTemptrrocr
7..1wthi4n rnpurr tn.Yn. cliltlne. well: :=1Ycw or t¢Yo
nntit,.u. re NMI. ter Alt tiaIll" n 00 a nu1kFr nl wden alr,'d r4ryfu
r. • ,ue mni, r P11 Amont. 6a11RA rl Mt. 4n44
8. %utuber of well% Lmuadnteted: 1
For lxti /q4 ,l; j. of 1 rr rvl- ern uerar �. rllptraYtt uric (lrr vanrcv
v,,m„ltr.•.me form,
41: Taunt wait depth teethe land cerbeit
t rb.rffri lIt t l di kink( I r•trinr l.e.,court
10. Stack eater fneel blow ion of cawing.:
lion'hnk diameter, 8 del
I i Well tonnirtellnn tlwthad: BORED
1 rsu Kr: raw. 'AA'Ie, direct puck Pfr..i
• wiunl 1
WRD
0
.5
n
81rrOl
2 to I .001
i0.
portland poured
O:QRd:&IN[i':1•iS1CdYtagtlt
PROW3 ;it
y 0 f. j 14 a.
Roil
filter sand
2
i+r€mOli k
AIFbR49' Mfl`tll
DS+1111iFt7OY Iigbi,AnMihrsd'RMtkl'Fr. yArn 410..1AI
sand moist to wet
tt.
rk S
Iw RErdeiteLs,
bentonite seal from .5 to 1
12. Certification:
Brian Ewing
Sl,±anur: r:c niried {Veil. Cumcwuir
Wpirn Iher nRm r h I arrtlfii 60. Idm InAlty0 .ey l a
e9 14114C .;(Y+or lyd Vr.la OTC ,n?1110 It C ?I'M)$r
etfi rnv.uifat .toriz.ua&rtr s .nkeu.maf.
7/9/2017
Dery
21 Site lhtgrani *r adrRtkrnal well details: �Jp
1°vit inn nee tit.. buck iN odds Nor Io Vital& adthdauNl hell situ J1�i1Uu 1oi awrzll
4nrbhtiehns Winds. You iriv :fix. mtaSadt 1ionht pa4es 11' he,t9Sa01.
atillm1'1 t.41. fNSTtICtIONS
Sad. For MI Wells: lkolne,I hits Cdtni
.tertwtmeuowtts lit' falbnv ng:
Disialon ur Water Bemires, information Pretcwwing lnit.
•. 1617 Ma8 r7549-16C*
JUL % A 2O t Enr blAxttnn Vet* ON1Po, ill addition rco catalog 14 o fool; le rslw: udtlfesa in
1Jli dbefe, .Inge shhum 4 copy of Ilan loan entim.ill Inc of tanlplintort of well
freedom In Mc following. JUL- 31 2017
Delwin of Water Resources,. Underground Inlet-deo Control Prot;rinl
1436 MAR Seryv�ice Cente'ar,''Riddell. NC 76t9'y16%
24c. FnrWaterSunnll & knit, r nr7;,lU s Regional
Alm slihluil one i av t ii ip 'ample; 6(
well aatanErtictime ru the ri.-PiiWV n Ih e� n�ii n :iCT[C ,mane where
iniannnCretl
FOR W':.ITERSC'PPLY WELLS ONL9'1.
1.31, Weld Wirral _-
ill. Binnitt''tilrn enact .
titrdiuil nt trt
31.1tmnt
Iharr tll rhica sI inllL1I4in eC eSt
f`Illh iti:�
'NnJ14 aRJJIM D ikteil
nr Ent IN n t mir .,rs1
iIc1
0
Ito 44Cd Arkjat!fll

*ELL CONSTRUCTION RECORD
Tlrei f rill uni b: ascii f.IR irlt;lc ns nmliiptir n•clle
J. WenContraetnr Lnfornaikrn:
Brian Ewing
'Ne1L1l9ntnnilrNi,Inge•
4240E
NC Ati•:49 Culinniout Ceninitnt* NILJI htr�
SAEDACCO Inc
i'.].il�giuly' h i it
t'nantiuciipn Permit #:
1lxg „V igoifuwreW li i$1 ia(et'ift re.c
.L Well Oaf Mho* mil asofrf
Water SnpplgWdk
ivnitlil1d
iu:ainil (iieaaing.Coo1inv Super
siii7ilr[uunllehi:il
❑li
Nall -Water Supple' R'elk
rillt'tronitnnno
-Injection Wdd
t1ARitiferNCCharge
n Ailinkr SLniugr :FM
nd.utafcr
ofN -pormumui rganiniogy
oGiuthehnaf f iota! Lnupt
oGeoducrmal OHcain'Cuul'G' ketatu}
4. Batts Wei1(y Comp
Well Location:
Vertex Railcar Corporation
flionldy Cheler Ntmx
1Trin-
,r4
iJTpluviLsitxif'Pldilie: _
tIR;ado Mot Wont Suppis{singlet
f iRlslth;ntnd 4i'nunr Sup* : :Jamb
oReunvrn•
noloplxlnour Raaosdiation
L14niintn° IR.mrcr
4lytrniaatcr Ilntl'mige
0541br+duiwo (.'annul
CITracct
MOOT itipluYn uiWer#' iStet
d,-, 6-29-17 WeIl Ji)i -2
r,;
II
445353
14, WAYSItlpNtle
FI4OM i tot
.5
.Irvin
M.t ttii7,K r91tt7eYtFla rt:41'natar.
.001 sch 40 pvc
portland poured
Mattnttnt,
filter sand
{ACr Suck
im
14 n, sand moist to wet
it,
Voilal. Itif-i,irROM*
202 Raleigh Street, Wilmington, NC, 28412
New Hanover
fit. L,utitude and t,ungituiir intik iv
e if N ail Hard. ±nm Iniduug Iv aid7S:o a°
Eimiing
re,rcd 11Ne111M:1 iirn NO
use 4owenuilo or Anima! ilparees.
in. Is urea the wethai: XPetththent ur :iTetnpvirart
7.L•tidaarepair Man nistingwri1 L3 i* or &No
at n1A ' zrgnilin RN i .alma 0,0 r-rer:roki lrrruern,-;i.in;hai ides 0,o r:ure(
t 1 , re8rr N'1n uia. u. r:au!e al IM tlN ;mck iiJ ff-s form.
S. %undier of wen§ motivated: 1
PPP WAWA, irrii-fief" .v s;w-nenwr uepli J PRI OISt i OA Owismnr
maynit.eery loan.
n Total Well depth helm* laud wirinrt• 14
I or 'FINN* I. ei4, oThirogny 11lrr I 4uxp9ti
Ill.Static water level below lop OleayiaC,t
I L Borehole diameter 8
IL Well construction Inabad; BORED
al NteCr rathiw,till^i� dirrci Rusk xt``I
Ip I: au:NE6t.
ormrsertolt koner. isnlntM;+a4Mdnkt{i.dour
bentonite seal from .5 to 1
22. (°crtffirntfna:
Brian Ewing ..
hlarnnlruii;rtificd !Veil !tonne 1i
Mr r.,., vi *ilia..-r£I rhnre f u n1. r;,-cjp . ci ii1R.w ens La
num .fit y!te' I?Y ,rA'or i@i AR if gf..apio of it
pp-ti,.oid) i.Te0.91,1 Ss rx:v 4',Ikti Tit annrl.
Zit She thai atnOr additional wtl detndy:
1 us Inn hi. Me book of this p dLn to piornlaaldiut'u ? ivclI sew d ant lie vccl l
wrap -action fieaiity, Sou non Alm n1L2vdiiddiliimhl pules if micbstan
4tuurwir l AIL..[W.1'tlt'i 10948
,y 2 n For .Ail 1Venrt $19,11111 3itts lama onion .f1 ILIt, of a:.Implati tl. aar vteit
7/9/2017
Date ,._..:. .
ritui
J' nr .n r :vdvnm
4umorG do A'Fkr[2i
RECEIVED/NCDENR/DWR
•AMAMI get' Water Remutrn, Inhumation Ptocntitig US.
1617 Mae Service Center. liaieieh. NC 27699-I6I?
JUL 2 7 2I�911h; For Ialueliltn W eIat)NL%t IuJ�1l4Joiaoltet ii%ah,, form to raw. Alt .
#a ahave. <the sltbnnl O I.opy Oti this lent! wilhnr {ri Jin_t of cumobrtFtn1 of
cur�yuruotr Or t1ts pago;vhi
(Saran;
FOR WKFERSLTPLS' WEL
13u, Yii4tl dzpmt
BLtufeetb,n toper
ONLY':
4Lelnmi ni limn
Ainrmntt
BMhiun nfWnier Rkytww'es.'Clp
16dtI Mali SertieiWn
antrmcaun to dw fnIksuing;
iimtml Foment"
�IOha -fir' ice
Z4r- Ear Water SuppK & Lnirctifirt .
:1Is4 sutnllii one .tap} of din fxirtn tr }rill in sinsni toipleiuni of
;veil .aasamctinn in the caanft' health depsirtnxnt ,orthe i:ouiit ahers
miritnrcOM
Form it if-1
%anL Cstti uvt Ea_
nn.nl iL' £m n111 if Marna ;tern I kUsnneee - Gn sem of itrgrnl1texn
Re‘ we4 Dux ..of

WALL CONSTRUCTION RECORD
Thin Term ca• Cw uuik Di 5411ple mr malarek ‘vvrt
1.aY'dTt'u itmumr'hrtnr eIMInu:
Brian Ewing
Wgltr'ormi,nir N,m,.
4240E
Nt W'oll Comae f'Wrtinwlioii Naudier
SAEDACCO Inc
(..4441410111.Nisi:
Z. Fi'c1I t'ntnntu;tian reentf
1t it nl' appiniefir - ttpr,nrj4.i fi r.. f'umit,
.L Wcdl Cte(clods v id ate):
WaterSupil"IYtdel
rLAgttsnllrn111
ClCicnnh ntol illenl;ig(Cooli
L1 0datn)tWCIimen:iht
❑ltiipntinn.
flitturommildinhlic
ClRfsidcndlit Winer Supt1q (single)
I`JRjsiiknottl. %tor Sup* Mond
Fe; firer
445352
Wig i
1 ll. SCREEN
p SWIM
3 11, 115 fta 2
I, ID
1 ornnlal
hl;nrSl#.
.001
tirtfloRS. M I*
sch 40
pvc
t41
GRLriYr:'.
Non -Water Snppiy W'rllc
02Mtnlnonno
rn WdI:
r3Al nl
tiArlul
OAfpafl
N41'thclmotoi
Or Rhernial (Closed Loupe
OGt' an hcmuti 111e.1lirg'Caoltw Re
4. Is;I Wrliivl Cumpl
54, Sidi Lomarn;
Vertex Railcar Corporation
Otteconere
EICimllndn'SBcr Rarlronflnnn
:S0hnity Barney
CI rimmwcriernerrii lge
OSidaneknce rentm.l
O'l'm art
Denim fl:lcpinm miler#3:i R
Ir 6-29-17 wen inmost-1
Fherldssera ter Femro Asada( ink n
202 Raleigh Street, Wilmington, NC, 28412
New Hanover
i.4Vtnl)
c5.ptk;jhl
e'1nt'rnr 5Mrmm C,'in IIII1 .Ip
R4ntl ll$nl'kcnllaU No Oran)
56 Latitude and Longitude in Ile gn alininoltsorstrnarl,ur decimal domain(
Mott( lipid tot Iin huti, ai tii itau
(1. 6 lire) the wtII(Oi r!Pcnrmnonl ur OTeulprrrarn
7. Is thin aniair Matt easfingw elh^. 7.7)Nes nr K11ir
{f 41 1rf,'t nhf mg, qur;trren r 2a9fa+n dnfir urmnrvnrli r;+ti.ot(Ise N„nurrrl9
r Y r ue Y'I'gil r of arch mina 4414 (.‘44 air:V
8. 'Sumter nt sells rnebinrctcd i,,,,__
h 4441.44(g 44tr441af,rui-„ar• ry,ph nuT
%a a dnr ffsnil.
n Total well depth behm land .u$ rev. 15
„riht)Nr toff. itF I InnTi tf drAttni ttr 4:1 POt T/
ran
10. Statirwater Intl below hrp of t!aaingt
0.(141e and el W4444 1,111+44; xt " -
11, 8nt%hnle diamcler: 8
12. Well arnstnettinn uu$hnd: BORED
r I e Im;w. rr.a citric ulna rrakUR:I
(tr.
0
0
35813141kK4
bentonite seal from .5 to 1
t
.5
15
15
W
RI%,
portland
al
-
filter sand
poured
2
2 'rlltnt�[
Or
alltetkilMlId4i4PltB`mecaxuxl
nvicalFRUa:ndonnal4nm„n341•.trthez-di NMriei
sand moist to wet
22..e entleadnn:
[Irian Ewing 7,9,2017
SIdu115r. =rf c It,lICJ}Veal S'unpcalnr-....... � , ; -...
Jr
M ;p lee rktr.nrnr;. r r') -rrOf v it 01I r t -r.rl 141011 uuJ sre ..,L4Ynar€
�IaVlr 15,14t II' li?' Arra,rr ri urtC 44 'C ,'Daft ltrilfin.-.Inhume tf r.r'Jx oar rho.,
+'a.NR I(0 .'r r m)'fact lri.1 t .44 rb 4-7144444nt.
23.$ht awake ni nddltinnul well details:
ntm nsu. llq:'ba:k fPllns rtyy.' (t ypw%tl :;uldidinnnl rs�.11 alle ,Idrnlf err moll
norm— mm details You mat gsj1'trllrleb NiCN pages if lie4asSltA.
a itnirrT,4I,1NllTilt,tii5N5 / ENR/DINR
?Alt Fier AS Wells( iubanl rill roan kiilnn in tkn;: ttf xmptctiot at *Al
mann R0 Cite r0110WiTT
JUL 31 2017
Dln Man ut Water Remnrem,. ttftamariun Protenning traits
JULy2017 MIT SL.I St'nicnt: ter lidera)). NC?7699-1617
ater(�uality Regions
2att. hrhran@wellq bn y:uger®tlaats r$@atvtha az Cann to "be addrr„s 411
2ill'4bata, ,Ilse a1d118d :r 4u Ijipli8gl.'alnrFig iltbaMyei uumplaCuia. nt '<t'eli
"nsrnnrian to (her lvllldivitrg-
Dh hiun of Water Reanunxs. Irndergraund !Medina Control Program,.
1636 Mi1I Sendee Centers Raleigh. NC 174 !19.14366
14c. Fir Water Suppty d@ tnl!netlnn Welkin
Also submit oni cups of thin diem waltan 30 thin afetlindelivn of
avmil camrnirtian to the (mono heahh department of the eauary where
cnnsmielen
FOR WAATERSG'PPLY WELICS
13a. Virdd (Rpml
13h. bisnfntinn apt ., .. .
nII
Amount( _
Rom Rom (e 0-1,
.1/40111 C`:rtctuw C*:pannr.ne
IUIYIIt and Neurt kQ nrecn
lttiIad Nryyvr n1t

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kirk McDonald
Well Contractor Name
4110-B
NC Well Contractor Certification Number
Practical Environmental Solutions, PC
Company Name
2 Well Construction Permit 0: na
List tilt applicable well construction permits (Le, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
°Agricultural
°Geothermal (Heating/Cooling Supply)
D IndustriaVCommarcial
°Irrigation
Non -Water Supply Well:
faMonitoring
Injection Well:
°Aquifer Recharge
°Aquifer Storage and Recovery
:Aquifer Test
°Experimental Technology
°Geothermal (Closed Loop)
°Geothermal (Heating/Cooling Return)
°Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
°Recovery
FROM
TO
DESCRIPTION
fk
ft.
ft.
ft.
1'
.
ble
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
°Tracer
laGther (explain under #21 Remarks)
4. Date Well(s) Completed: 02- 1' Well IDS MW-1
Se. Well Loca n:
W Atim tko
ker
Facility/Owner Name /r (fey with;
ID# (ifapplicable)
I51 NOCVO `OYtJLk 1' °,`�eith; ia" rvC
na
15. OU
FROM TO
ft.
:R CASING (for mauve/I ed weenyR LINER (ifs ice )
DIAMETER In. I THICKNESS MATERIAL
ft.
Physical Address, City, and Zip
New) 4aHdpr '
County
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient)
34.2067 r/ N 72. 57f/5
14. INNER CASING OR TUBING (geothermal closed -loop)
THICRNESS IAMATERL
FROM
D ft.
TO
2.5 ft.
DIAMETER
2
In.
, 9. ft.
e.b ft.
in.
PVC
SC RIC. py(w t
17. aIJHCGar
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
FROM
2.5 ft.
3,5 ft
2 i^•
0.001
Sch40
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
I
1.0 It.
2 .0 fii
bentonite
pour
0 ft
1,0 fe•
concrete
pour
ft
ft.
19. SAND/GRAVEL
PACK (if o apliable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2.6 ft.
%.0 ft
#2 torpedo sand
pour
ft. ft
20DRILLING LOG a
.((fie 3.'liM
k.
.D H.
Firms
R.
(.0 ft.
re.
fL
ft.
ft.
ft
Parcel Identification No. (PIN)
6. Is (are) the well(s): ©Permanent or °Temporary
7. is this a repair to an existing well: OYes or allo
(}•this is a repair, flit out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
S. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with
submit one form.
9 Total well depth below land surface:
e same construction, you can
(ft)
(ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing:
$water level is above casing. use "+"
11. Borehole diameter:
auger
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
ft.
ft
21. REMARKS
ttfralr•o
earrigiaial
ertinca pion:/ Off
22.
coof Certified Well Contractor
By signing this form, / hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provtded to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699.1617
24b. For Injection Wells: In ; ttihr •rli qr�(2ih1�eeaaff�0�rm to the address in 24a
above, also submit a copy of this form uI147P/? q =i• pietion of well
construction to the following:
Division of Water Quality, UndJ fouspl ,injescfi1n Control Program,
1636 Mail Service Center, 1 iV(ti 9'699.1636
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Date
24c, For Water Supply & Inie Wells: In addition to sending the form to
the address(es) above, also sub itt 3(i�'ld�ittp
completion of well construcWriap
where constructed.
within 30 days of
US:l 4'd#artment of the county
On Regional Office
ttachnddihonal aheeta ifneccaear•.
DESCRIPTION color.. animas son/rock a rain size etc.
Form GW-1
North Carolina Department of Environment and Natural Resources -Diviaiov of Water Quality
Revised Jan. 2013

1 T'fl
445137
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC 28429
City or Town State Zip Code
(910 )-231-6669
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT# %A i oRq 15-
OTHER ASSOCIATED PERMIT#OI applicable)
3. WELL USE (Check Applicable/Box)(: Residential Water Supply 0
DATE DRILLED O-�O-
TIME COMPLETED 3 't 00 AM 0 PMO
4. WELL LOCATION: CITY: (,n > t ‘M;
ouNTY IF-LADOVe
Roi Cive- La. ast-►.1
(Street Name, Numbers, ommunity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC/ ETTING:
0 Slope 0 Valley It Flat 0 Ridge 0 Other
(check appropriate bgqox) qq
LATITUDE I1./S
LONGITUDE
Latitude/longitude source: 0 GPS o Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
5 OWNER'SWELL OWNER
NAME 5L/QM](/�6 I
Qa f
�
STREET ADDRESS -ag
eye Ln,
.lr ��ll a.agq
City or Tow6'66- oCi,17 Zip Code
Area code - Phone number
6. WELL DETAILS: c
a. TOTAL DEPTH: (�
b. DOES WELL REPLACE EXISTING WELL? YES 0 ,' NO
c. WATER LEVEL Below Top of Casing: -� FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS'4 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .01118.
All pp f
e. YIELD (gpm): Bo METHOD OF TEST l ltk '
f. DISINFECTION: Type J r Ft Amount /2. tbS,
g. WATER ZONES (depth):
From`CV\ To sr) From To
From To From To
From To From To
7. CASING:
1 Depth Diameter
From 4-4. To -in Ft.
From To Ft.
From To Ft.
8. GROUT: Depth
From n To --3 Ft
From To-'30 Ft
From To Ft.
Thickness/
Weight^t/O M IVCi
Material
nn Method
TL�
9. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
11. DRILLING LOG
Frgm _ To
c
Formation Description
cans/
11 ni:e548-11e
JUL 1 8 2017
intory la►tyO�n P-y�:lpt6ysl`J Uch.
l2. REMARKS: s1r.V4,VEI1`-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INA CORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND WORT OF THIS
RECORD HAS�EEN P,OVIDEED TO THE WELLA I
water (one s�na�n e g 1�
,,�1�1 n Reg
SIGNATURE OFLCERTIFIE L'L'LONTRACTOR DATE
Michael C. Sage
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1a
Rev. 3/07

PnntForm-
WELL CONSTRUCTION RECORD (GW-12
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contactor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit N:
List all applicable well construction permits (i.e. I/IC, County. State, Variance, etc)
3. Well Use (check well use):
WP0291481/LOE131
Water Supply Well:
DAgdcultural
DGeothennal (Heating/Cooling Supply)
DIndustrial/Commercial
"Irrigation
Non -Water Supply Well:
`Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test •
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Rehm)
4. Date Well(s) Completed:06/02/1
5a. Well Location:
Josh Mihaly
DMunicipal/Public
3Residential Water Supply (single)
Residential Water Supply (shared)
DRecovery
['Groundwater Remediation
Salinity Barrier
DStormwater Drainage
[Subsidence Control
DTmcer
.}Other (explain underlt21 Remarks)
7 Well mit N/A
N/A
Facility/Owner Name Facility ark (if applicable)
7500 Anaca Point Road, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover
R04408-002-009-000
County Parcel Identification No. (PAN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient)
34 16 26.8 N 77 47 45.4
6. Is(are) the well(s)E% Permanent or iniTemporary
7. Is this a repair to an existing well: ['Yes or liNo
If this is a repair, fill out known well construction irjormadon and explain the nature of the
repair under 221 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 160
For multiple wells list all depths ifd(gerent (example- 3@200' and 2@100')
8
10. Static water level below top of casing:
If 'Wier level is above casing, nse "+"
11. Borehole diameter: 0-4O/8n40-•,J (Ira)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
(ft)
(ft.)
For Internal Use Only: ,} 4 4 6 3 3
14. WATER ZONES '.
FROM
TO
DESCRIPTION
ff.
ft.
ft.
k
15. OUTER CASING (for mnlUsued,wells) ORLINER(if ap Iieable) ,
FROM
TO
DIAMETERTmCENE55 MATERIAL
0 it
40 ft.
6 b'• LSCH40 IPVC
16..INNNER CASING OR TUBING (geothermal elosed loop) ..
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ff•
140 ft.
4 to
SCH40
PVC
ft
ft
in-
17. SCREEN-
FROM
TO
DIAMETER
SLOT SIZE
TRICKINESS
MATERIAL
ft.
ft
in.
R:
ft
im
18, GROUT::
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
23 ft.
Bentonite
Poured
f.
R
ft.
19. SAND/GRAVEL PACK
(if applicable) "
FROM
TO
MATERIAL
EMPLACEMENTMETHOD
R.
Kt
20. DRILLING
LOG (attach
additional sheets ifnecessary)
FROM
TO
DESCRIPTION (color, hardness, soil/reek type, grain sire,eta.)
0 R'
11 R.
Sand
11. ft.
38 ft*
Clay - Void at 38'
38 ft
95 ft.
Limestone
95 R-
135 ft-
Clay/mud rock
135 R
160 ft
Sandstone
ft
R.
21. REMARKS
JUN 6 2017
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
HTH
a
13b. Disinfection type: Amount: 3 ° 9
Form GW-1
22. Certification:
�•DWQle)
06/16/17
Signature of Certified Well Contractor Date
By signing this farm, I hereby cent& that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0109 or 15A NCAC 02C.0200 Well Construction Standard, and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this
constnlction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Ralaiab. N.G 99690r1437
24b. For Infection Wells: In addition to sending theiform to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following: Water Quality❑Regionaleef_
Division of Water Resources, Un(Iel;t,�,i �ggo� �p�lrrqr�o�ram,
1636 Mail Service Calif.', ' : C` 48h9� k3d°1
CEIVED/111CDOIRIPNift
of well
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
�Geothetmal (Heating/Cooling Supply)
Industdal/Colnmeleial
Irrigation
Non -Water Supply Well:
%Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:5/25/17
5a. Well Location:
Invista
QMunicipal/Public
®Residential Water Supply (single)
O Residential Water Supply (shared)
©Recovery
❑ Groundwater Remediation
®Salinity Barrier
0Stonnwater Drainage
®Subsidence Control
Tracer
f Otber (explain under #21 Remaeks)
Well ID#PTW-4
Facility/Owner Name Facility1HO (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover R02400-001-001-000
County Parcel IdentificationNo. (PM)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
34 deg. 18'2gq7''.62 N -77 deg. 58' 59.50" ��
6. Is(are) the weI(s)jPermanent or DTemporary
7. Is this a repair to an existing well: fYes or ENo
If this is a repair, fill outlmosm well construction information and explain the nature of the
repair under 021 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the sane
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 54' (ft)
For multiple wells list all depths if different (example- 3®200' and 2®1001
10. Static water level below top of easing: 10.89 (ft)
If linter level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct pusly etc.
For Internal Use Only: 444011
' 14. WATER ZONES . . .
FROM
TO
DESCRIPTION
h
R.
It.
ft.
15. OUTER CASING (for mild
-eared wells) OR LINER (ifap cable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
+1.5 ft
24 ft•
4 is
SCH40 PVC
16.1NNERCASING ORTOEING(geothermal
closedd00lb "..
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
h
ft
in.
17. SCREEN -
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
24 ft
54 ft.
4" in.
0.020
SCH40
PVC
ft.
D.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD &MIOONTNT
0 h
21 f •
Bentonite
Poured
ft.
ft
ft
h
.19.SAND/GRAVEL
.PAClC
Of applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
21 - ft.
54 ft
Coarse
Poured
ft.
B.
30i DRILEINGLOG(6tte
b addidooalsheets 'Ifnecessary) .
FROM
TO
DESCRIPTION (color, hardness. son/rock type, grain size, etc.)
ft
ft•
See Attached
ft
ft.
ft
O.
ft
R,
FP "e Nit
ft
ft
h
JUN 2 6 2011
21.REMARKS'si51
ntorcna4CV 12 Ctifte"
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Fenn GW-I
22.
anon:
6/12/17
St_„ ure of Certified Well Contactor Date
By signing this form, I hereby certify that the wells) rere) constructed in accordance
with 15A NCAC 02C .0100 or I5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources!) • asin Unit,
1617 Mall Sen'ice Cente'N,DWR
tint Fprfn fa
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submitone copy of this form JUL
a of completion of well construction to the following: 3 2017
Division of Water Resources, Underground Injection Control Program,
1636 Mail Sendce Cente 27699-1636
r ua Ity Regional
24c. For Water Snook & Iniectiorai�lJeGr'Atdt➢(B9ree g the form to
the address(es) above, also submit lZHAgtf)itl(eisHp, l 0 days of
completion of well construction to the county health deepaam' wen o the county
where constructed
North Caroline Department of Environmental Quality - Division of Water Resources
Revised2-22-2016

BORING LOG
INVISTA
4600 HIGHWAY 421 NORTH
WILMINGTON, NORTH CAROLINA
PTW-4
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 5/25/17
T ss
kit"D
rr fi
4 S ROTION b� " >x t�
5 �1 �2 r a;� �� ����r
�,�.
3 aeR ,
L' NTENT>r
a
fCOU
0 -20
Light gray, medium to coarse grained sand changing to a tan to
light brown sand with minor organic material.
Low to
Moderate
MR
20 - 32
Tan brown, medium to coarse grained sand with minor gravel.
High
MR
32 - 49
Light brown to beige, coarse to gravelly sand mixtures.
High
MR
49 - 54
Greenish -gray, fine to coarse grained sand, changing to a dark
gray, silty dense clay at 54 feet.
High
MR
MR - Mud Rotary
RECEIVED/NCDENR/DWR
JUL 03 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

PTW-4
Lock
Ground Surface
♦ 4
0' - 30' Bentonite•
'♦♦♦�
♦
♦♦♦4♦♦♦1 0
ry♦♦♦4•• ♦s♦M En
t' 1DTW-10.89' t'••i i • �•�•
•
•_ •••••L
•
i ••
•
�
��.���•
I • • •
I 4 �,%%
� ••:•:•: r•• ••:•
!••• • 4 '• ••••
.•• 4 ••
•• �••••••
'••• 4 '• •
•••••• .•••••
••••• I••••••
•••••4II •••�•
•.••••. ••••••
.� ••4�••••••
•••••4 �••••••
.••••4 :••� ••
•••••. I •••••
•.•••%—y•••
•� ••� _I •••�•
� • •••�•:••�•�••
•••••••
1.5' Stick Up
l
t
30' - 63 Sand
63' Total Depth
33' Riser
33' - 63' Screen
RECEIVEDmCDENR/DWR
JUL 0 3 7017
Water Quality Regional
Wilmington Regional Office
Note:
DTW = Depth to groundwater in feet
as measured on 5/30/17.
-443/44\
Applied Resource
Management, F. C.
Hampstead, NC 28443
TITLE:
Well Construction As -built
JOB:
10038
SCALE:
NTS
DATE:
6/12/17
DRAWN BY:
EFC
WELL ID:
PTW-4

Print Eot
WELL CONSTRUCTION RECORD (GW-1)
1. Wen Contractor Information:
Donald Cummings
Well Contractor Name
2412A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (.e. U!C, Counry, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
aGeothennal (Heating/Cooling Supply)
Industrial/Commercial
' Irrigation
oMunicipal/Public
®Residential Water Supply (single)
Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring ©Recovery
Injection Well:
❑Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
7Experimental Technology
OGeothermal (Closed Loop)
' Geothermal (Heating/Cooling Return).
4. Date Well(e) Completed: 5/24/17
5a. Well Location:
Invista
❑Groundwater Remediation
®Salinity Barrier
fStonnwater Drainage
Subsidence Control
°Tracer
nOther (explain under ft21 Remarks)
Well ID#PT W-3
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover R02400-001-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iatdong is sufficient)
34 deg. 18' 33.16" N -77 deg. 59' 05.23" w
6. Is(are) thewen(s)0I%Permanent or 101Temporary
7. Is this a repair to an existing well: ®Yee or x®No
If this is a repair, fill out Nomm well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 61.5' (ft.)
For multiple wells listall depths if different (example- 3(200' and1W100')
10. Static water level below top of casing:
If water level "above casing, are "+"
11. Borehole diameter: 8" (im)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push, etc.)
10.26
(ft)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type:
Amount:
Form GW-1
For Internal Use Only:
.14...WATER ZONES
.1`"�,'.b ld;
FROM
TO
DESCRIPTION
ft
fe.
ft
n.
15. OUTER
CASING (fof
mult-eased wells) Oft LINER (ifap Hcable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
+1.5 ft.
31.5 ft
14 la
SCH40 PVC
16. RCASING
OR
NG (geothermal etoaed-loop) • :.
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft.
in.
ft
fr.
In.
RDIAMETER
FROM
FROM
TO
SLOT SIZE
THICKNESS
MATERIAL
31.5 H•
61.5 ft
4'• it
0.020
SCH40 -
PVC
ft.
ft
in
IS. GROUT • - -
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
0 ft
26 ft•
Bentonite
Poured
R
ft.
ft
ft.
19.SAND/GRAVEL
PACK
OfanplkableP •t".
FROM
TO
MATERIAL
EMPLACEMENT METHOD
28 ft
61.5 ft
Coarse
Poured
ft.
ft
zo. DRILLINGLOC(atta"Eedd)doaal
sheets .Ifineersary) "'. .. A .. •"_
FROM
TO
DESCRIPTION(groin size, hardness, aolVrock type. gsize, eta.)
fL
ft.
See Attached
ft
ft.
tt
ft..
ft.
ft.
RE.E
7 k .) D
ft
ft.
2
ft.
JUN 2 C 2017
2LiSEMARESc . ` Ir
L. s.Go ,.r.,wa4&1 I) I 1t1
DWOft C€;
22. Cetlit-leaden:
6/12/17
Signature of Certified Well Conti' er j k, 1 Date
By signing this fain. I hereby certfy that the well(s) was (wee ) constructed in accordance
with 15A NCAC 02C.0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the veil owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resourc AWD DWR
1617 Man Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to senfling the form to the address in 24a
above, also submit one copy of this form 301r3s nip?spletion of well
construction to the following:
Division of Water Resources, Undeag5ooqnd Jpjec •on Control Program,
1636 Mail Service CenterYl'fLIhIWily6RRES261ai
Operations Section
24c. For Water Sunnty & Iniertionl6Ydll1)niteop a Ibrpaji form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health deparmrent of the county
where constructed.
Nonb Carolina Department ofEnvironme tal Quality- Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA
4600 HIGHWAY 421 NORTH
WILMINGTON, NORTH CAROLINA
PTW - 3
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 5/24/17
DEPTH
4 (FT.j� a
k � �ESC IQlf4N , '% ,tom
r r - _ 4 „ $ C
�x�r,A� ���`tsr�"?.°� ���„�,�x'.., .r-_i_:s"' .r�'�i-;".,,,:....
a i
WATER.
CDNT�NT
...
'- an c
B(,QW
COUNT
•,,,, ,
0 - 5
Light gray, medium grained sand.
Low
MR
5 -15
Medium brown to dark brown, fine to medium grained sand with
a mixture of root and organic material.
Low to
Moderate
MR
15. 35
White to beige, fine to coarse grained sand mixtures.
High
MR
35 - 47
Tan to beige, coarse to gravelly sand.
High
MR
47 - 60
Dark greenish -gray, silty to medium grained sand, coarsening at
depth with minor clays.
High
MR
60 - 62
Dark gray, silty dense clay with gravelly sands.
High
MR
MR - Mud Rotary
RECEIVED/NCDENR/DWR
JUL 0 3 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

PTW-3
Lock `+
Ground Surface
0' - 30' Bentonite '♦♦♦l
♦♦♦i
30' - 63
•
Sandi
T
1.5' Stick Up
,0' - 33' Riser
.♦4 1DTWbO.26' I
•� �•� •��•�•�•
•• •• ••••••
•_•_• • • •
•_•_•: ►�•�•�•
•_. •= I •••�•
••.•.•—►••••.•
•• •• ••••••
••• •�•••
•••••lI ,•.••••
•••e •I �••••••
L.•_S I 0•�•�•.
1=•�•�•
•••
••••••
0••�
•••.•
•
•
••
•
•_•-•, 9 ••••••
wen
••••� ••�• •••••• • ♦ Water Quality Regional
• • • • • • • Operations Section
Note: Wilmington Regional Office
DTW = Depth to groundwater in feet
as measured on 5/30/17.
61.5' Total Depth
33' - 63' Screen
RECEIVED/NCDENR/DWR
JUL 0 3 2017
-.4%\,
Applied Resource
Management, P. C.
Hampstead, NC 28443
TITLE:
Well Construction As -built
JOB:
10038
SCALE:
NTS
DATE:
6/12/17
DRAWN BY:
EFC
WELL ID:
PTW-3

Ft' Print i`61167A,
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412A
NC Well Contractor CertificationNumber
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit Th
List all applicable well coma -action permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
N/A
Water Supply Well:
['Agricultural
®Geothermal (Heating/Cooling Supply)
[' TndustriaVCommercial
1, Inieation
Non -Water Supply Well:
rglyonitoring
Injection Well:
®Aquifer Recharge
['Aquifer Stooge and Recovery
['Aquifer Test
❑Experimental Technology
©Geothermal (Closed Loop)
fGeothennal (Heating/Cooling Return)
4. Date Weil(s) Completed: 5/22/17
5a. Well Location:
lnvista
['Municipal/Public
®Residential Water Supply (single)
® Residential Water Supply (shared)
['Recovery
['Groundwater Remediation
® Salinity Barrier
['Stonnwater Drainage
®Subsidence Control
['Tracer
['Other (explain under #21 Remarks)
Well rou PTW-2
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover R02400-001-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
34 deg. 18"37.33"N -77 deg. 58' 59.29"
6. Is(are) thewelI(s)CIPermanent or ['Temporary
7. Is this a repair to an existing well: ['Yes or x['No
If this is a repair, fill out A71o11n well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 63' (ft)
For multiple wells list all depths if different (example- 3@200' and2@l00)
10. Static water level below top of casing: 7.91 (ft)
If linter level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only:
444609'
14. WATERZONES
�.
FROM
TO
DESCRIPTION
ft
ft
ft
ft
15.O TERCASING(formulti-easedwelts)-OR
LINER fap Usable)',
FROM
TO
DIAMETER
THICKNESS MATERIAL
+1.5 ft*
33 ft
4 1"
SCH40 PVC
16. INNER CASINGOR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
R.
f.
In.
ft
ft
M.
FROMFROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
33 ft•
63 ff.
4" la
0.020
SCH40
PVC
O.
ft
io.
18. GROUT', .
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0 ft
30 •
Bentonite
Pou ed
2
ft.
ft
ft.
19..SAND/GRAVEL
PACK
'Ofmakable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD`
30 R•
63 ft•
Coarse
Poured
ft.
D.
26, DRILLINGLOG
(atta
E'addlditmd sheets if nee ssarv)"".`:d:.
FROM
TO
DESCRIPTION (color, hardness, soll/rock type, grain size, eta.)
fL
f•
See Attached
ft
ft.
ft
R.
ft
a
5rR�"CEi\fE
W �-c„F �..n a ..
ft.
ft.
R.
ft.
ft.
JUN S'C 2017
21,RENTMIf3. .. - --
IUAt:irnao-t+vlr` 49:4�Ut`h
nw(;/tiCta
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
Signature of &41Sd WOContractor
6/12/17
Date
By signing this form, I hereby cent that the well(s) was (were) constructed in accordance
with I5A NCAC 02C .0100 or I5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells,: Submit this form
construction to the following:
Nedavq,e(firthr wR well
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigk l)(CZ769-161�
24b. For Iniection Weils: In addition to sending
ththe Inn [ ddress in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following: Water Quality Regional
Division of Water Resources, Unagqsggypp gfigi uatl a fpjifrogram,
1636 Mail Service CentefrIt
NeStOPERVINISittfice
24c. For Water Supply & Infection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed. -
North Carolina Department ofEnvironmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA
4600 HIGHWAY 421 NORTH
WILMINGTON, NORTH CAROLINA
PTW-2
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 5/22/17
EPFH
{} tRfY� p;�1 hl,ga�S -iR tIt iN`"n a yid i i tX�
f�UE6 �$1�t
1
Cf%NTEf11Y
BLOWY
kC UkJ,r`:
0 - 10
Tan -gray to light brown, medium grained sand with minor root
matter organic material.
Low
MR
10 - 21
Tan to dark brown, medium to coarse grained sand with wood
fragments.
Low to
Moderate
MR
21 - 24
Tan to light brown, medium to coarse grained sand with wood
fragments.
High
MR
24 - 45
Tan to beige, coarse to gravelly sand mixtures.
High
MR
45 - 52
Tan to beige, coarse to primarily gravelly sand.
High
MR
52 - 59
Dark greenish to gray, fine to medium grained sands changing to
a dark gray silty clay at 59 feet.
High
MR
40 - 55
Dark gray clay with some gravelly sands.
High
MR
MR - Mud Rotary
RECEIVED/NCDENR/DWR
JUL 03 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

PTW-2
Lock
Ground Surface
0' - 30' Bentonite
30' - 63 Sand
•
63' Iota Depth
1.5' Stick Up
•
0, - 33 Riser
•
33' - 63' Screen
•
RECEIVED/NCDENR/DWR
JUL 03 2017
Water Quality Regional
Operations Section
Wilmington Regional Office
Note:
DTW = Depth to groundwater in feet
as measured on 5/30/17.
--1/44.1\
Applied Resource
Management, P. C.
Hampstead, NC 28443
TITLE:
Well Construction As -built
JOB:
10038
SCALE:
NTS
DATE:
6/12/17
DRAWN BY:
EFC
WELL ID:
PTW-2

nt Form ;
WELL CONSTRUCTION RECORD (GW-11
I. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412A
NC Well Contractor CertificationNumber
Applied Resource Management, P.C.
Company Name N
2. Well Construction Permit #: " "/A
List all applicable well construction permits (i.e. UIC County, State, Variance, etc)
3. Well Use (cheek well use):
Water Supply Well:
°Agricultural
()Geothermal (Heating/Cooling Supply)
° Industrial/Commercial
Irrigation
Non -Water Supply Well:
nMonitoring
Injection Well:
°Aquifer Recharge
['Aquifer Storage and Recovery
°Aquifer Test
DExperimental Technology
3Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 5/23/17
5a. Well Location:
Invista
o Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
°Recovery
°Groundwater.Rernediation
❑Salinity Barrier
°Stonnwater Drainage
o Subsidence Control
°Tracer
o other (explain under #21 Remarks)
Well ID#PTW-1
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover R02400-001-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Ia dong is sufficient)
34 deg. 18' 42.34" N -77 deg. 59' 03.62"
6. Is(are) the weU(s)E Permanent or ()Temporary
7. Is this a repair to anexisdngwell: °Yes or X°No
If this is a repair, fill out bnoun well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 63'
For multiple wells list all depths ifdjfrerent (example- 3@200' and 2@100)
(ft)
10. Static water level below top of casing: 8.0 (ft)
If water level is above casing, use ••+••
11. Borehole diameter: 8 (in.)
12. Well construction method: rotary
(Le. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
For Internal Use Only
444608
14...W RZONEs.".
.�- ... - ..
FROM
TO
DESCRIPTION
ft
ft.
ft
R.
15.:OUTER CASING (for
mull casedwells)ORLINER (ifap livable)'
FROM
TO
DIAMETER
THICKNESS MATERIAL
+1.5 ft
33 ft•
4 'n•
SCH40 PVC
1f.:INNER CASING OR. TUBING
(geothermal closed -loop) '" ...
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft.
in.
R.
ft
is
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
33 ft.
63. It
4' 'a
0.020
SCH40
PVC
R.
ft.
in.
UIOM
FROM
T
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
0 m
30 ft.
Bentonite
Poured
ft
R.
ft
ft
19 SAND/GRAVEL
PACK(
if applicable) '..t '
FROM
TO
r MATERIAL
EMPLACEMENT METHOD
30 ft
63 R•
I Coarse
Poured
ft
ft.
20. DRILLING
LOG tattle
Itaddldonal sheets Itnece nary) -.:a .,r,� ..':
FROM
TO
DESCRIPTION (color, hardness, solUrcek tvpe, grain size, etc.)
ft
ft'
See Attached
ft
ft.
ft
ft
ft
ft
_
E EIVCCL:
ft
R.
S 6 2017
ft
D.
,UN
21. REMARKS CTo.,?lro+fn-{ Yfk:3}£F3�L4t1--)i:>i• '"
;S
Duvo/)CQ
ANis I
Signatureo Certified Well Contractor
/12/17
Date
By signing this form, I hereby cer tij that the well(s) was (mere) constructed in accordance
With ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
QI,BMITTAL INSTRUCTIONS
24a For All Wells: Submit this form within 30 days of completion of well
construction to the following:
24b. For Inaction Wells: In addition to sending th� tp n ,44 a
above, also submit one copy of this form within 30 o u pl'I', i of well
construction to the following:
Division of Water Resources, Underground 111014B1)101.4111IFIIRM1011311
1636 Mail Service Center, Raleiiggh,,rlt�not AfliSectIIOnff�
24c. for Water Supply &Jniectlon Wells: Idi9¢dltl6xgs s'e2Ye1.9 0 P#ss�
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Division of Water Resources, InforRVE�VroceEDstmCUnit, WR
1617 Mail Service Center, Raleigh, NC 27699-1617
in 24a
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2.22-2016

BORING LOG
INVISTA
4600 HIGHWAY 421 NORTH
WILMINGTON, NORTH CAROLINA
PTW - 1
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 5/23/17
DEPTIjt
�*.v (FA)
r' 3s� DESCxRIPTioN * s �� * � k 7 w
F+"'• } 6 ti4 {1 t{h"v2
a.`' „+ttv **. ya)r �: � -,
5• WATE4. $ k
(
OrMI N Ak
m.,
@ m i
� „,, NT :.
0 - 10
Light gray to medium brown, fine to coarse grained sand mixed
with organic material.
Low
MR
10 - 22
Tan to dark brown, medium to coarse grained sand with minor
gravel.
Low to
Moderate
MR
22 - 35
Light gray -brown, fine to coarse grained sand with some gravelly
sands.
High
MR
35 - 51
Tan to beige, coarse to gravelly sand.
High
MR
51 - 59
Greenish -gray, fine to medium grained sand, coarsening at
depth to gravelly sands at 57 feet.
High
MR
59 - 63
Dark gray, silty dense clay with gravelly sand mixture.
High
MR
MR - Mud Rotary
RECEIVED/NCDENR/DWR
JUL 0 3 2017
Water qualitySection
Regional
WilrrOperationst
gton Regional Office

PTW-1
Lock
Ground Surface
0' - 30' Bentonte
30' - 63
Sand
1.5' Stick Up
_a
63' Total Depth
0' - 33' Riser
33' - 63' Screen
•
RECEIVED/NCDENR/DWR
JUL 03 2017
Water Quality Regional
Operations Section
Wilmington Regional Office
Note:
DTW = Depth to groundwater in feet
as measured on 5/30/17.
Applied Resource
Management, P. C.
Hampstead, HC 2a443
TITLE:
Well Construction As -built
JOB:
10038
SCALE:
NTS
DATE:
6/12/17
DRAWN BY:
EFC
WELL ID:
PTW-1

WELL CONSTRUCTION RECORD (GW-fl
1. Well Cmteactsr (nfprmadon:
t�A KcLL ZZT,we
Well COnlractoklaao
9.159
NC Well Co or ceniftmmn Number
A CQ,A.rc Werfl ID 2/ J I N
Company ttuno
2r Wdl Construction Permit a:
Oa et/ oppfkable wall wnt i.tnanpermit: 41 e. (a/: Cowry,. as *mince. etc)
3. Well Uso (ebeck wen use):
Water Supply Welk
DAgeiealtural OMuniapallPublto
noeothunml (Hee(ittp/Gcaffng Supply) QResidentid Wider Supply(aingk)
3Indtesu'ieUCommemial f Residendsl Water Supply Calmed)
iniSadon
fNoa:Weler Supply Well:
Mmilaring
WN
Mallon I:
®Agdfer Recharge
()Aquifer Storage and Recovery
°Aquifer Tat
plttpetVmeMal Teohnolog7
jcwdarmd (Closed Loop)
1Geotftermal (Ileadne/CoolioaRetum)
®Rocmrery
Dcmuedwster Remenidion
f Salinty Barrier
(3StmmwaterEiaag/
QSubsidtmo Control
Minn
fOtltar'Caantain under N21 Remains)
4. Bete WW(s)Completed: C'79—in Wed IBa
9a. Wdl Lacedoo:
�Q. P...a.A.r.cK
FM liry/Ownerleamn Paddy mN Orappeaable)
432. f d,,ohymete !2R lUr1.4- due.„ a 8tfol
Phyeidl Mats% (My, ad Zip
pea.) Seg later
County Punt lduaiAadion No. CNN)
db. Ladmde and longitude In degreeslminut seconds or decimal degrees:
Orwell Odd. onelaMlmaiseuR cicnfl
3v0 /yr vsr N o» ° s'o ,.�447
6. hare) the well(s)iPermaneoe or ()Temporary
7.1a tap ■ repair to ao eating well: °Yes or fipfo
1flhitlearapaln.ddoulhnpwn wallcanAnrd/w *maim widaplaln fhar ftweir fhb
nyalr way ar/ nnarfomato Yr op lhs honett(m/r/ornr.
3. ForGeoprowHDYr or cloladdalipGeotbermpl Wails having the same
construction, only I GWd is needed. Intimate TOTAL NUMBER of wells
drilled:
9. Tafel wdl depth Pelow load earlaee: r
prism* walk Saari lep ' ydij9(rmit (mnnp(a. S@200'aad f@Iof)
f0. Static water level below top areasing: r
lfwaierlevel is above Ming. me "+"
it. Borehole dhrmeten to qn4
For Internal Use Only:
444545
,la TOR.SZNEAr; e: e.:1 1r• •••n ON . r• , •
a O ft I sr ff. c wars so—1 .
ft. ft.
'.I& tYWINCWINGdot added dn OR:LINMEM
t'O OMMb'=ER 1 Tatm aai6
*ROM
t R.
Gott .., IL. I OIL 0
sliaWweTaa
is
ft is
MOM 'lice
R. ft.
as
MAITRIAL
•
MATZOSAL
vaaM l TO
,u"I2't
PIAMR7R
Mess=
U(O
6cands
OM
MATtWAL
aL
N.
in.
NM YTO
tot IL
I f.
Wendt
t�a6a
IMPLACIardiT ahead a AMbat• �
fees -- -rAmto
ft ft
latOMMISMILI
MOM
ft
m
TO (MATC11IA4
€M.MACXtMONTMRTI(OO
O.
O.
fr.
a.
f.
dean30afahaltpi".: n . .;I;W�r;..•:.:1:
fe.or. b.dam r�atltorpambedheoar
CCCDVED
JUN % 22017
I rdarnatslP
OW o, s OG
23. Certifies
9liaeuro.CCaafeed Oar Disc�/�
By aiming M1r fang 1 arty tee mat mewel((e4 war (overt COMOVCrad m (lran't&
wit HA NOV MC4100arWNW; OXC.OTeo Nta Con*nw/ae ffimwbnb ISO(
copy ymaneardhosbernp/ovidedrote well owner.
•
23. Site therm 6r Additional wdl detains:
You wry use the back of this pogo to pmvidt additional Wait she details or w
e nsbuction details. Yon may also.dtaab additional pages if nanny.
SUBMITFALI RUCTIONS
24a. perWaIIM Submit t is loon within 30 days of completion ofw
coaabaadon totte following:
Divided of WaterRtsoercm. latbrmatfon Mcesfng L'nfr.
1617 Mall Service Center, Raleigh. NC 27699.1617
24b. Ror Medina Web; In addition to seeding the item .to the address In
12. Well construction melted: ,auova�om, eduction
submit one Copy Of this fbm within 30 drys of completion of w
ti,a,auaor,rMay.able. doecrpaakato.) RECEIVED/NODE NR/UYYK iontodeN:Ilowinp;
mum of Water Resorts, undergo:mud lideceoa Control Program.
1636 Man Service Center. Raleigh, NC 276994636
(0.)
NOR WATER SUPPLT WELLS ONLY!
13e.Vidd(gpm) Method often JI IN 26 2f U
13b. Dfdakcdon type: Amount:
2de. For Ws Sanely Sea_Inntdoo Wdlo: In addition to sending the With
the addrenes) ahave, also submit one copy of this form within 30 dam
completion of woti votMwdfon w the county health department of We tout
Water Quality Regionalw`Art"' "ate
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW.ft
1. Well Contactor Information:
G.0 vs 4 n'n .te
wen Comnxioneleme
NC Well Cayman f esilio don'Number
A Q:A.1, (,t -e" D J t t N Q
Campos Neal
a, WNI Contraction Permits:
Alx allapMleaMc tarn eymaapaaian p rndis (it plc:. (,Frwry. S)it padaeen etc)
3. Wallin lank well use):
Water Supply Wed:
©.Agricultural
1: Geodtrnnal ffteating.Cooting Supply)
QlndustriavCwnmercial
Kaftan
Nina-WAtee Supply Web:
°Monitoring
IaJreden WNI:
°Aquifer Reeble
[Aquifer Storage endRecovery
DAquiRT Test
.3 Experimental Technology
aoeodtermat (Closed imp)
flGeohrermat (HefeingrCooline.Return)
°" Municipal/Pabtio
°Residential WNW Supply (single)
° Residential Water Supply (sbared)
°Recovery
°Groundwater Rcmediation
()Salinity Harrier
DStonnwater Melinda
°Subsidence Control
°Tracer
Maker (expla)a under 821 Remake)
d. Date WNNs) Complete& 5 /, _f7 welt 100
5L weft IAehian:
core Yea r$
Eeoaiw/Owa s Name paeans RMe efappaeable)
3O( 6uc.Cact .Est w:lu b)4C.
Rosati Adana, City, ad Zip
County Pahl Idandeation No. (PIN)
5b. ladt tic end Inpgdede In degraalmenutea/secoet et decntosl'dtgrees:
Orwell field,00s lar/long iswuRcient)
34° //• 357 N 077°5.4/a 4 w
6. (dare) the well($ Permnneet or °Temporary
7. Is this a repair to an adding wall: °Yes or WNo
par e a repair, fallout loam wdl cengavellolr iynnmhaMarand explain the nataleat ilia
rapalrwider edl rommhyawAhm nr tar the bask *laity fon.
S. For Geoprebe/DIT or Closed —la Geothermal Wells having die sane
construction, only 1 OW -I iO needed. IediateTOTAL NUMBER of Wells
drWea
9.Total well depth tided Ind Sarfaee: Si (fy
Fa SSA*wally iltal *Pik' 1dUI'ou (exempla. S ` On'and3@IM1T
It Sark water level below forOttasipg:
Ogler lava is above erring me "c•"
II. Dbrebotediameter: 40 Gn') REAENED/NCDENR/D
eo 12. Wed ,strucdoe method:.9s
ay
{l.a. allot: (otary, gable, dbeet poly an)
FOR WATER syrinx WELLS ONLY)
061
JUN 2 6 2u17
For Internal Use Only:
4444544
eULLOi
FROM KO —......_R cu rise
9611.
It.
(oK ft.
It.
CA., r•S SAAA4
' 1i'OVFER MINOR,/
MOAI
I d.
;fa •ifelR
PROM
a.
ro y
go '�warn
To
ft.
old met.: a • LENSRCd' I .
gamer® s MA'R1RA'AL
Octo ,o0a_
DIAMETERSERROIROD= au'rmtaL
tR
DIAMETER
a, ID.
R
R.
1e.
nag
yoR
To
O.
%II to 1 0/O
DIAMETER SLOT SIZE
,o.
MATWI AL
tHIC S
Oc/ao
Pj le`
MATER4V.
EMPIaflMtNrba,7ROD
TO LIIRE^snp etabhareeew.aoal'mk eR+ ma'eno6 AM)
tot n
ft. I re
ft.
A
a
tL
R.
R
1:7
Signature ofCai' gad sneer tato ^
8y onofirlo ha ten& du Nee walla' gam Oruro) aOAn2wlad In ado
two MSAIM ICOZC 0100 or ISA NCACO2l.' .OZOG Welt Canadian Stab aid Of
copy oathreeoNhar bertprm'idedre Swell sworn
23. Sit diagram dr additional wall details:
You may use the back of this page to provide additions well site details •or v
congaudion details. Youmay also mad) additional pages ifnecessary.
.SODMIPFAL INSTRUCffGNE
2Aa. Fnr All We Submit this loon within 30 days of completion of v
a alsmradontotheWorded:
Divb%norw.ter Resenrcra, InlOrmadon Procodng Volt,
• 1617 Mail Servie Center, Ralelgb, NC 27699-1617
gat $sir fnketioe We in addition to sanding the film to the eddmss in ;
l3a.Yldd(gpm) Method of test:
Water Quality Regions
a3b. Diainfeedoo type: Amount: Qpintivescelttigp
a also submit one copy otshis form within 30 days of completion of v
construction to the following:
Division of Water Resoareea.Uoderwested J»J, a Control Program,
1636 Mad Service Center, Rohe,, NC276994636
Ur- For 1111fAtruanty & MRieedoa Wens: In addition to seeding the fomi
thin addresses) above. Also submit one copy of this ton) within 30 ANN
completion of well oonsemafon to the county berdth depaltime of the eta
e,rs. Omen el
wnmington Regional Offic

WELL CONSTRUCTION RECORD (GW-1)
1:Wel0 Contractor Information:
G49 y Mews
Well COJ*I4 le
NC Well Camelot Catalonian KWS
AIAscj wed! 0211 11 ..vs
Company Nolo
2. Well Cooetrnclian Permk#:
Met all alyeleable wwtl canftruenon pwmne fLx UK.', Clmaty. Slate. Peran WO
3. Wed Ueo (check well ace):
For Internal Use Only:
44493
FROM T TO Rr$CnIRNH4
J CcjatS SAN/
ere h. 3 g ft.
h. I
>x3-v19rBR$Sjitc melt w
it 7'O
MATERIAL
..DO h. a III Oli 0 I .DJ
Stela MEMO* DINIMIMIDMEIMMOOM:.
PROM
t0
RIAMMER
MAILAIM.
11.
fr.
Ia
n.
h
la.
Water Supply Well:
Agrioukund
Geothermal (Rea dWICaolSig supply)
y�yIndustrial/Commercial
IQ.IRlmalon
on -water Supply Well:
IMmtitoring
°MtwdeipabFablie
f{Reaidentiai Water Supply (tingle)
©Residential WOW Supply (shared)
®Rnmaery
DotoundwaterRemedimion
°Salinity Barrier
°Stmmwata Drainage
Experimental T ahrloloav °' Subsidence Control
Cada:md(Closed Loop) °Teaenr
Geothermal QleadnilCoogna Return) Motet (explain tmdec d2l Remake)
A Dam Welds) Completed: Sr" a H Ili well ram
$a. Well Loudon:
C1¢JQ SA"kerS
PROM
0 o ft
ft
TO
Sr IL
ROOM
It.
. a Ira ft.
0.
tt
h.
R.
Manernat star R
/1A/ it CO/C
It
1nrel:Nre,
O I(•6
MMLUAL
ems.
,..YMPIACEAffiff mamma a
per-_ 4-1va
Igjeendn Wall:
Aquifer Mann
Aquifer Storage and Recover/
Aquifer Test
Eaailiiy/OvenaName
$'.f 6 S 1I Emye L.N
Physical Address, City. and tip
tharvetre
Cowny Panel tdendawtion No, (PIN)
SA Latitude and !online in detreeslininutes/semndr or decimal degrees:
Orwell field, at let/long is sufficient)
34° /n r S" )) N Ot) la 4ve 9JP w
6. Ware) thewdl(s)OPermanent or [}Temporary
7. fa this a repair toan cabling wall: Qves or Mato
/%ehty la a repair, Jill oul town well ennsuucglsn nJyn wr m anderpfan the namreafthe
ego. e21 remaraaaialia or on do &deg/MMitArm.
8. For Geoprobell for Closed —loop Geothermal Weds having the same
consuactiogDaly 1GW1isneeded. Made TOTAL NUMBER ofwelk
drilled'
1kMity ma (tf epp&abte)
9. Total well depth below land surface: 31 (k.) 2da, For AB Wells: Submit this foal within 30
For multlplewellslastolldepdutrd(pbwu(example 1V00'and 2�1001 eonsuu'ctiontorhotbibwing: days of completion of Wcg
Ir
OT9
a
PR
OM
b
TrRIAL
0.
0.
anr1ACItMzstMGAMon
Wartidmdia_dNYiireli aideih'iah a'avk:
To
wx9ommoN taaw, Roan. soma* Ma Cara OR, 00
it.
ft.
R
ft
k
ff.
ft.
0.
h.
ft
h
RECEIVED
JUN 222017
:mrREMil8.142a '.
n tu'i'i ;e oWaeoo �0l inn
22. Certifies : .
Riga
S'earn
Dat
10. Sblk water level below top destiny
((wafer keel hallow:Meng urn"+
/"
11. Borehole diameter: LO fin.)
By wow Air firm, ?WPM the weil4) way (were) miasmal in accordance
walk IM Rate 02C .0IOD ISA NCAC 02C•0200 Well Cawnccjlen Stnterdeand Mai
copy aphis record has ken provided of the watt owner.
23. Sic diagram or additional wdl details:
You may use the back of this page to provide additional wall site dctailt or wall
construction dotads, You may also Mach additional pages if ncamsery,
RUDMf1TAL INSTRUCTIONt
(fa) Division of Water Reaoureaa, information Prveeeeing Unlit
1617 Mall Service Center, Rate*" NC 27699-1617
Zdb. For Wootton Weft: In addition to sending the form to the address in 24a
12. Well construction method: fie' wA�'4f-RFrF����f���ttla��lalt(r��I,�� above, also submit one copy of this form within 30 days of completion of well
(i•n ataery envy, able, dreg meant)
++•aVtletrll�hto the following:
FOR WATER SUPPLY WELLS ONLY:
131. Yield (gem) Method of test
13b. Dieiafecdoa type: Amounts Water ONaI
Divlaba of Water Raouras, Underground iojemioa Control Program.
,((�i''AGM Mail Service Caster, Raleigh, NC 27699.1636
`Y4.For Wager Sturdy & Injection We ha addition to sending the form to
dm address(es) ahovo, also submit one copy of this eons within 30 days of
err
itr ( I ion of well wnsirudton to the county health department of the county
Section tM ar
Wilmington Regera ionsonal Office
JUN 2 6

WELL CONSTRUCTION RECORD (GW-1)
I. Wall Con6eabr IMormatoa:
ridsWdy :T e5'
Wen Cohtrntaame
e9-199
NC Wall ComnmdW CtnikeadonWumbu
AGt.ti.l.e3 wtf1 _Oe((t.t,et
WapAitEant
well Construction permit it
tie 011(.tpilo Ale well 171170111001Prffnit. a.0. (PIC. C emote .94ee, panalnr, teed
3. Well Use (cheek veil use):
Water Supply Went
Agricultural O' MunieipalMublic
deotkamd (I{eating/Copting Supply) QWsidentiai Weser Supply (Single)
heilubsriaUCommerelal ()Residential Water Supply (stoned)
n-Water,Supply Welly
Monitoring
Median •Wen:
Aquino Rawest
qu(for Storage end Recovery
Agui*tTea
i imaim*Mal Technolol)'
Geothermal (Closed Loop)
©Reooray
Dcroundwator RomediMion
QSulinity Barrier
©Stonawater Ovalness
DSabsidetme Coattot
QTncer
('eode:miul(fieetinfiCaolillR,Return) Mika kettle vada#2) works)
4.Date Well(1) Completed: Calen Well ID.
Sa. Well Lannon:
Aso .. /Loom r
For Internal Uee (hn(y:
444542
id.wA
reoDM'
o1a2TrnoN
70 R. 3s- n Ceiftr
It.
R
FE OUTS
id Et
�SPalk n$aae.wa L1NR Rai
nn
n m in. 01/40
trit
ro
Is.
MA'[exML
tt
t6
171t)CnEE1N'
eo
3Sr
tin
robs
MOT ftera
OLO
7NICRNIma
UCfa
MA7aa
B.
iw
A�`INBfIT a/6SiMn�
&IIRML
R.
jM►uceMENr merges
Fantivy/UwwzMaw padnty nit Bast tatik)
OG Wyt..r o ireARA Olt a.c . COI FA
Physical Addm,W/,Cihland yip / • a 001
Aiwa1230-or
Cody FetedIldmdfarian No. (PIN)
Ms Ladtodeand Ioggt ode hi degreealioinuteahccomdo or decimal degree:
Onion gala, ow Wag 6 suttSeuq
31e a . Sv pl Oen fie drat, W
6. Ware) the welksai 'ermanent or fl'A'eeriipuraiy
7.Isthis arepairtolaflitting well: Ma or OTkr
HMIs a a nmab.,pl(oWhdawn well cananrerar mfonnononad;mid n l6v nature of the
avow weer sat remurtraaaioo ur mrlho eater ofiMYfilrin.
Si For GeoprobeIDfl or ao.e$Lopp Geot)sanel WeRahavbg die some
coashuatiott only I G 1/-t lauded. bona 'rOTALNUM)3ER (dwells
drilled:__.^
1. Total wdlMOW tii!Iov'faedSaralee 3zr (e,)
por.nidllple waled la'iod()apnea Y:tafareli (cbcmpfa. fl20a'awf2S1001
1a Shdewaeer lewlbebw lop oteaoigr /9' CRT
If water level iv above c'u6 q. as "+"
II- Borehole diameter. on.)
R
22. Certification:
9iaaA(umofCdM6ied'
Bit aB'Mk
WlM 11.1NC:AC
copy tarM r
ILL
Unit
Trirorrrwt:'
•
61-0
des Dam
1 Imreiete that We %e#(4.. Is (red avnerralld in sac
'C.0l00 ur I94 AY'itC#ZC.02001 bRCnnnnwelan Stair* so
Sr 6aNr proriatdto ding owayA
23. Ste diagram or Mahal wdl detail.:
Yob m4V use Ulf buck of rhos page to ravine edelnonal wall site details
construction details. You may also aheadadditiuMl pages ifnozssary.
SCUBMUTAL 1NS7'Ai1CAl1ONI
2M. ftr AR Weds: Submit this, fan) within 30 dap of eompletion
Aoestlaedon wthe olbwing:
owes or Water Researces,detbrmation p. rocaslag tinily
1637 Mail Sete Center. Ralegh, NC 27e9-e617
pe��
I2.weRea0alruptieemethod' -n tNtt9�fdi'''VED/NCDENR/ .. copy
consttation to die following;
BR dttYapfeompletm
lan or WaterResoarea, Uedesgroand lajaciimn Control Preget
a636 Mon Seeyke Costar, Rakish, NC 27699-Iddd
24e. fetwater Snort & Inteelaoo Welk: In addition to sending Ste
giaddteds(os) aarrolso e, asubmit one copy of this Yam within 30 d
outipNtlon of weS COnaruotimi to the county health dopanment or the
rjbmiereetenereti
Il,a aliya', raspy, addle d&eet perk ere)
'FOR WATER SIMPLY WELLS ONLY]
13e. Meld (gpm) Method of teen
JUN 2 6 LU1
136. Deenrecdon type: Amount: Water Quality Reg
+Rrr.bti& s
Wilmington Regions
Tn addition to sendieq the (ban go the arse
kH also submit one of this form within 39 ' n

WELL CONSTRUCTION RECORD (CW-1
1. Wall ('marketer Information:
A P I� 'Tn.xS
*�o
Well Cmtmde em0
9-4 ei
NC Well Coalamor (knit -notion Nombat
Al Rw, S (,OeJl
c`nmpany Nemn
2, Well Conscacdao Portlier:
Da..1(..v4
httt tOoppilmole turd unl.vcrh&vpeneln (a.e. C11C.. (Nay -Aft PoNanar. any
3. Well Use (!Leek Well PO:
For Internal Use (nly:
1-9a5�
FROM '� ESCmreWN --
DM b 3S- fa eCaaJ r Sneer
R I R
TSODTRRCki9YCOW 'a Watt
DMMtWaR nnCYNaaa 1 MATER' t•
In.
U4a
JQ
AGINNRR
raem
R.
et
To I mA
R 1 Es
MATERIAL
1L
Water Supply Well:
Agioutturai CIMunioipel/Pubtie
GetBtamel (Fleeting/Cooling Supply) ®Residential Warr Supply (angle)
)ndtutrialYCommercial DResidendal Water Supply (attired)
as
MOM
,0M
re.
pr
a.
art
bk.
SIRS
Oc o v4(o icv.e
FROM
on -Water Supply Welk
kle mt
�isedont 'Wilt
Aquifer Recharge
Aquiltr Storage tad •Recovery
Aquifer Tea
:I?xperimaate! Technology
Goadtcnpal ((Nosed Loop)
Ganhamd (HeatiSCoollea Rattan)
DRemvary
Deroundwater Rumedimien
DSadinity Barnet
OStonoweasDrainage
DSabsidente Control
Drawl
flOrkvr (cxpian under el Remarks)
4. Data Wei¢) completed: Cs l —a'7 wow
Se. Wed Landon:
Seat ttyer=
vadtity/OweerName.
MTUCitioP P R
OR
ao a.
egad"....—g-hA'wP
h. l rL
.1
TO
R.
n.
EMMA 1111 i' METRM
ra
flit
n.
h.
hotali teiRi hulas... eeuglYres
N.
b
row
b
lams IDs rirapoaeoble)
SA): VAR N C•
flesicet AdITashCitttty` end Zip beittoi
A)4Aa N r
C:Nmy Peed rdendlkarian Na. (PIN)
Sb.latitude and Iaiglade in degraalrahnitesheronde or dedmed I eee:
(AMU chit. ma Fauloan.is sualoka0
3y ° l3 r, Bea 1 N o» °S, a. tar
6: Glare) the weltiele Permeneat ur DTehaporary
1.Is this a reinter to anextadog Went OYES or Otto
llrhn Oneepaflaawhnown wadmnannien MJanricttdoordrideWa ewwcpllw
Moir UMW n31 ranMa. etdia, or enlhe batheamlane.
3. For Geoprobe/DP.0 or Claaotl-1 aopGeoothermal Walla htving the sane
aoasleudion, only 1 GW-t is needed. Indicate TUrAL.PISRURof wells
drilled:M ----'—'
9v Total TMI depth bdow:Eaa4s.rtscer . 3 $ (it)
&wev&lylr we ap thwnllda:sbsydrmt (emoppa• 3fiala'aa42@l0n9
1.6$Mde*oar Forel brio* lop ofcasinge /a"
trifles, level itOwe wig, we'& "
11. earehine diameter.
12 Weg rrmarruedea method:
augea FORM mo* direct pa s)
n
R
R.
Jtitd- 2017
Its
DWQ/BOG
22. CcrflticaSOat
Siggtouro of Relied tYdl eat Vas
al 410118 NAsP% r hrrj Set 5k' lh dry W I wa (wors) witaouacd Mom
with /SA fit AC. 0104100 (9A CAC Oa .0200 Well Cawnwfiun &marnty an
aryimk IswNMs & eepriakao4e sWrmmer.
23. Slted)agnate dr addldatkl with details:
You they use the bark ot this page Jopmvlde eddidanel well site details ,
construction details. You aay OISO Math addaiond'pages ls'oacesswy,
'ef ehltiITAL INSTBUCfTONg
24e. For All Wlgd• Submit this tome within 30 days of completion t
gemination tothe following:
DWI*. of Water llpmtrcau harowi atioa Promoted Unit.
1617 Mal&&Nlce Cea&er. Rareigb.NC 27699d6t7
(in.) a Bar lolectton wtat in Widen to sending the ram to the address
RECEIVED/NCUENR/S4f= also submit one eapy of this Poem within 30 days of completion
constiuction.mthe tbilowinr
(IR)
FOR. WATER SUPPLY WILLS ONLY:
13s. Weld (gm)
tab: Dialafeelioa tyre:
Method of eett
Amount:
JUN 26'01
Didion of Water Ream* Underground InJealion Comet Progrr
1636 Mali Service Centee, Raleigh, NC 27699-1636
24e. For Water Sanity & lajpedoa Wd6: In addition to sending the f
Water Quality Re i ddEhQQ Wrests) above also submit ono copy of this form within 30 d
Y 82dlnhkdon of well cnnstruedon to the coats bedth dapaaned Of the
pis tither. rnnetn Rya
Wilmington Regional Office

WELL CO STRVCI'ION RECORD (GW-11
1. Well Contractor Information:
17s9 gat_ n.
Well Cnredeneleme
lc wall Cmttrat Cedilcishati mbar
chimney
t).A./t% cO °Ol OJ�N Q
rr Neale
2. Well Conti -actin Permit d:
tin ea Ioapliett wa0 eaaatrautm pconav 4e. WC Comfy. .Slate, rooms% «e )
3. Weil Use (cheek well use):
Per Internal Usc Only:
444340
.ye.Wibv '2O
WA n
�a' 11
a.
t ,.n
BPS -.911vin
Otto
t
Water Sappy Welk
©Agrte'ulmral
®Qeothmmal (tieadng/CboWng Supply)
DlndusuiwVCommercial
earn
I�Von-WaterSupply Welk
ljectioman7c11:
MunieipslInbIie
Resichtal WiasrSupply(single)
°Residendal Water Supply (shared).
©Racowy
Aqu)br!tetharge
"Wiles Sage and Recovery
jAquifer Teal
si'x. parimenml Technology
Qmdwnnai (Cloud i'aop)
Qoreundwatcr Rdnedistion
®Salinity Narr1er
®Sformwater Drainage
®SubsidentnControlDrrnedy
lticolbcomai (Hradnu/Cootin a.Aaum) f Ocher (omtahi under a21 gametes)
4. Batt Was) Completed: /P - Woe ifto
Sa. Wall Locedeh:
111111211
0111111111111111
yap
h.
�a FYI
idle'
O
it
dn.
/
lacilityIOwewNemo
'WOW 0)il (i(yfail4ble)
(9 n nou; n•- oz -43.Nk a. a 449
Pbyattal Address, Pry end24,
Slir9 Pslu�
C:outo sled ideIicims1 No. WIN)
ate. latitude and rottgltade Ialdegr, edmiautts/smonda or detimar aa(Pec3:
(iywell fV;ld, me IbVla g le sofftciaat)
3'I 6/o Sa'9 N 611 aS'i a 13f w
6. G(are) the well(slwmanvat or ()Temporary
o
Ms thisarepairto an mimingwdh DVea or l�io
Irmo ire moors weadtna+rraakn hrAneartdn �iderpl� one thtmime*
WWI media. e2/ reasdaawa,un or M the Oa&ofMk farm.
S. For Geoprobell)f [ or C'loem•1.00p Geothirthh( Wdrsifarlingshe same
coastmation, only 1 GW-I is needed, Indicab'(OTALNUAOIER of wale
ddlad:
9.Totalled) death ltelow.bndsntaee -Sale
r'tu nuhlple wells Naiad degas (fdlaan d (etwnp/c. 36tzod'od42ig Pea
id. Static wwtertwat below top of emasgs
I/ water Ie'W Is Sow owing. ant "6"
11,Borebotodiameter Co (in.)
12, Well etwarnetloa mtIbad:
O a aegor. Mary, rnak, direct Dub. ate)
a(a.
(IL)
04
eat..its LIMNS
-
R
rb
a.
R.
.,,
M
a.
Int
JUN
TT—
',
OWcyaoc
22. Cerf ado%:
Sigaamreof emf
Con
Oro t
Da
ay man", r stura , •-•y to T Nat Me Wad oar Sty amsowere4 fn ace
WiWir M4NC:ACO2C. cr/SANCACO2C..a20atrettOmirnsrarnFrmdndnsn
coward* moordhm•6eao.pmr(dedrothe weeonwe,
23. $kc diagram dr addltlodalwell debits:
You my use the back of this page to iodide additional well sic details
construction Snails. YOu imay also attedeadrlitianl.pages ifttooSsary•,
¢SURMrfi.AL1NSTRUC[7ONS
24s, Rot AN WdS Submit this form within 30 days of completion t
doMMevan t0 titefbllowtng:
*Salon or water )amources, Ihfdrmatloa AnicersIog Unit,
16t7 Malt Service Carter. Raldgb„ NC 21699-160
244 For ,Inhu %ion Wan In addiction to sanding the Pm to the ddreas
aposvEINNCDENR/nftso submit ono copy of this form within 30 days trf completion t
alas to the blowing;
FOR WATER SI/F'MS WnLsONt.Y:
13i. TIth1 (Wm) Methodeast:
136 Diainfetiou type:
JUN 2 6 201
Auroun*. Water Quelity Real
tjpelatlui+a Sea
Wilmington Regional
Melon of WaterResourcea, Uadergresatd IajaMiou Coahul Progn
) 1636 ma7&Med Center. Raleigh, NC 27699-1631
2de, 'For water Saaoly & taleedoe Wells In addition to sardine the f
the tams** above. also submit one copy of this owl within 30 d
7RwOodtion of wed *instruction to the county beallh dapemrmitt of the
nekton lummeted
Office

�Indtauhi Commercial
t
PE.
ISSupply Well:
gMonitorinIrg$
action was:
Aqutkr
WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
Gs it9 Mn.x
wNl Convect
am
NC well Conon Ce tifieadon timbre
A aL,..,9 unit 0lb1ItNQ
Cwnpway Nwa l
2, Welt Coostntadnn Permit a:
Idw al!apahcMla will.nrnmraa**n IdeM#10 An WC.. County Rog. PiffIn en coo
3. Well Vet (cheek well use):
Water Supply Wee:
Jrtgricumaal QMtmielpnldroblie
hamat (ifpdag/Caoling Supply) QReeideMtar Water Supply(single)
()Residential Wafer Supply (Stewed)
FurInmmalUse 01444453,
it
a ft so it coats SALA.
IL ft.
o tngscftswilarm' _ GIRL
R IljJ
Ili. MIMS Gltfdte
n.
atAM
R 1 1 b.
R I rat
7ntOcNrss 1 MATERIAL
Ok0 j ,oat
MSS
tqi
MATON^
re
PROM r0 Wet. Oft. ,3 b m. / `
a. 0.
suns
0/0
MICI nn66
Coe
Reding
3Aqu)fir Stmrge and Recovery
Aqutfa test
experimental Teebdologvv
nRceove y ,
Daroundwater Remediation
("Salinity Barrier
()Sto mwata Drainage
OSub'sideme Control
anal (Closed loop) Q'Iteeer
1Cle otmoa) (Rea rine/Coolinultetum) fOdta(nnbin under fill R'dlosNts)
*.Date Weigh Completed: 4',42en Wee Iola
Sat. Wen I.orluiee:
R
shrift l fini'1 lgetti iidjYtilidE :N .
MOM . TO MA7.OMAL
R ft.
£MPMACRMtlet MBIROI
R.
R
G IM
Faepity a Nam
(943% 4:8/`gtsf, O+-LJ
PhysicalAdders, City. le
.ma
AA% XiOsOjN .
10 1 osstwa
anr� rpa)rw,A 4aa aa.(a.k�
Pftayi !(tfawleobte)
!L/e at tO/
Coi.nd. Parma Idmdaeadon No. .PIN)
Sb Latitede and iuefiita& to degreatabnnts/oeeonide or decimal a¢reen
(ifwed field, ore ltWk I1 b wffafoot)
Ye ° mg /That alb N 077c . 012—,
w
6. tUare) tbowelledraearmamet or ©Temdornry
7. le this a repairto an satins web QYas era*.
(imk ire ad/awllMown well eoumnreaen lnfenecrion,aMeapIS Mu woe *jibe
moo e2l.mwra.nun tor an IMbeta* rojeN. Iwo.
B. her Geoprobe/DRT or Cloet oopCeo hernial Wd tfhaving7he sauqu•
construction.only 16W-tisneeded )odieeleTOTAL NUMfRdfwelb
9. Total'wdi depth below fandaahee: _30
fbrmntlpicwas# lltlmfdepron fdlgdnmt Ammp& 30l0O' n4N$Idar)
ReMaWater tem,below top dean, /If(tl,)
rimier lawefi above s&sb.a OM "+'
I1. Borehole diameter: 6 . (In.)
ft.
R
ft.
R
R.
rt.
/
R
ptk
m
RECEIVED
Ji)N 2 2 2017
information Processmg�.)
uwuIt( 3
32. Cerallicatiem
Gc
SidastvreofCdp'fiadData
.Cal gs`or
Sy Spa refsMr, kat* 05'that far well(n) wan (ward .wndmeted 1n ale
wari ISA NCACOYC. or !iv( 1141MC 0.0 4210 liEd Cana o Sava an
copyotNlfa Mend. b mFANS: in/tewdaawaa.
23. Sire diagram Or additlrital well details:
You may use the book of this siege to provide additional wag site Moils
cat edon delaiis. You may also shah add'dianelpags if emessary.
SURMLITAL INSTRUC1nONS
lea. For A8 WO*: Submit this mire within 30 days of completion
coasfruction to the Saibwtng:
Olvbfonof Water Rctoanss, fefninetton rmcessing Uait,
1617 Malt Semite Center. Ralefgb, NC 27699-1617
±* For telethon W.Us In addition m gaoling the form to lire address
•
12. Well coopaeedoa loathed; �tr� ` W^�'td�r�. a�r�[Mbmq aril submit ono: copy of this form within 30 days of completion :
(ie. auger, nem mole, dimes p ti, ne) r/LCEIVEDIirWG�to the (bllaWil�g:
FOR WATER SUPPLY WELLS ONLY:
I31,1iIdd(gpm) Method Mat: JUN 2 6
13b. RiNa&bcllou type: Amount:
!)Mdom of Water Resources, Underground Iujocdoo Control Preen
1636 Mail Senses Ceatrr. fib, hie 27699-1636
=agar for War SaoiW do Toicednn wells an addition to sandi%g the p
the addtess(ds) above. aim submit one copy of this tone within 30 d
completion of well consevetidn ut the county health depetaneat of the
jene,note.rtmtt
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW. )
1. WdlContactor Information:
t Mtety A./el
Weocur le sae
t-J `i 9
NC Well Comma* Crrtifica(ortNumeet
A( .,t..) we-n o,a7
Company Rana
2, Well Cdantraetion Permit it:
l.a, ati v$1 vthk wail ttnrinmaan permae (le. (tit?. County. Man, FaSi,ce,, ette/
3. Well Use (cheek well use):
Per Internal Use (MD:
444538
�yr p' /_'e99's. 54
n
mien
13 OISTP.R tA'SING'ffoe'tsift taed:BROM To i!e
era R. TomeIL
itv ERC �47iiRii(S�RBd
ONOdir' ).
1tBcaacs
eTamat,
0ko
IWOM
h.
DMME
h,.
sae
MAeaarAC
ft.
Water Sapply'Weth
Dooleuitmel ©Munielpaupoblio
QGeothemtel (tfeat(ngitoorm6 supSy) f° Residential Wear Supply (singlet
IndaStriattCommercial f Residanda! Water Supply (shared)
Noe -Water Supply Well:
Mortho
ivil
«Ilan We
anon ell:
Aquifer Recharge
©Aquifer Storage and Recovery
3AteiferTest
0Remv.ry
©Groundwater Rehtediation
OSalinity Harrier
OSton water Drainage
313maimmdalTothnohsgy QsubsidendeContra!
'Geothermal (closed Loop) Draw
r IGetrbemnf OltaelnalcootinaRotund ®Other (tumldn under 421 Ramada)
4, Bata' Wdq!) Completed: rras'Y7 Well JDA
Ss. Well Cantos:
wee,. /C >tLl
i1
yd rt.
7 o e"
n.
a
*ltt.
COY
o/ 0
Tae4an'tlSa
090
Funi(y'ownerlireme Pulley WAR spaamtile)
"Dr) L.3.1, aa. r) Ll•. to L Lc, MC- area,
Phyaital Andres, City, ad Zip
Thapwrir
County .Patrol ]dmtiatarw No, (PIN)
a Laltade and dvagithde in deaienhoinuresloe ends or dedmpl degrees:
Orwell Sold, toe lag:own sunhat)
,$y 0 Oil , 432"N el, o cqr 66'6
6. Wet) thewell(s)12cPermanent or °Temporary
7.1s this a repair to an tabby well: t' Yee, or duo
(rnaisa gala,fRattorgwnweaaoxmwtion*maimaadstplam1*0 moanNJdw'
mete W.hr MJ! re,norl axtahm won As MY.60AI,Jnn.
a. For GeoprobeRWT or Closed -La Geothermal Web having the same
construction. only 1 OW -I is uteded. Indicate '(OTALNUhgSSR of wells
drilled' 9. Totel well depth below.land aarfue: 4.1
For mWttple weds llftadibyths yam (brampla- Avow en
It Static andertevel below top of a tg:
If water lavrl adi.G. casing: ace'_,"
11. Porthole d(ameter:
12. Well $aslattioo method:
(La aagrx, roomy, able, direct eta. aM )
w
(k1•)
0.h. 'z
h
R.
/go'
Pour . tit AAtP
h. ft.
N«:
WON
1L a.
MeldttEMeta' Dtnt
a.
A.aaan.o.ar.. .
war uar.:.n ra4nwagt .tom
R.
(a
it:
it
(1.
h.
n.
Rt-gar-[VJ-i?
rt.
f
a a
'g> mvdd :: •.:.:. .Jrik)„ ttiodvracra un6
JUNI 2 2 an(
22. Certl6eatloa:
S4rotwoof edw.,,fI„ tower tkte
ay eirefg NW farm rob). ale dart t(ta aell(a was (we ql cvr.rrucad is aft
wale ISA NCACO2C.0(00er 1.14 NCAC 02C',02e1 WellCnarnnmkm Santo an
CopyetklymeaHue ban p wdded(usewenawner.
23. Site d)tlgbam. or add{SoMaal well deaden
You ma use the back of this page to provide additional well site details •
consbutdmn details. You may also anal additimel pages if namsary.
$ RMITt'AL DISTRVCtioNA
24a. par All Wens: Sabmit this tent within 30 days of completion
donshuation to the Snowing.
fft•) Division aster Raoare%htfRDtatlon Precession Uh(t,
1617 Mall Service Center, Raleigh, NC 27619-1617
24b.157r lnleadm Web la addition to sending the farm to the address
te.rld..r RECEIVED/Naos/ w arnit ens ewY 0f tide Rim within 30 days of completion I
eons aim. theffollowing:
FOR WATER SUPPLY WELLS ONLY:
tea. Ykid (gpm)
Method of test:
(3b. Dion:kaiak type: Amount:
JUN 2 6
Water Quali
))Wieroq of Walter Undergiabad Itt(eetlon Control Prep
2917 1636 Mai!'Serv3a Other. Raleigh, NC 27699.1636
26e. Essitatclusgthasiossw W adde'tian le sendlog the
the addiess(ee) above, also submit one copy of this (men within 30
SENS of wall cons5acr)on to the eoenty heahh depmbrtont of the
istetrompurtom
Wilmington Regional Office

WELL CONSTRUCTION RECORD COW-12
J. WeltContractor Information:
12c U Rr; „e-
WelI Comsat ow
NC Well COMrmtOt CCn fleation Namher
Aa,as coco 09.e1L
Company Nana
2, Well construction Permit W.
NT
For Internal IJsc Only:
444537
.'i&WATB$'ZON68..
psDM
iro
• M.
ldu u(1 almn&aMt xC11 pmnrnndhMlwrmaa (le. (UC Cramp%, Marc, panaw en:)
3. Well Vse(check well use);
Water Supply Wen;
JAgeicaiturel QMunioipaI Public
'00coutwmsl (Heating/Coofng Supply) ©Residential Water Supply (single)
]IndrutrWUCommerciat f Residential Water Supply(shared)
oe•Water Supply Well:
Monitoring
-lOjsetloa Welt:
°Aquifer Redhable
°Aquifer Storage and Recovery
°Aquifer Test
]Experimental Teehtalogy
3Qeothermd (Cloned Loop)
fl<kvtheawel (Hanina/Coonne Return)
rbeaorery .
Qfboundwaler Remedialion
DiaiWity Barrier
OStditrroastar Mikado
DSubsklonce Control
arrows
nether (ahtplein under O2i RemM:ks)
1a Olrft.R
'th
A
warawnom
cams AQ,A
(beau
:46.:lNIelt
POOH
d.
M.
TO
e7,aQt6�. • . . .
goe. e.
n
PROM TO
e1oM
Aped
U R. ao
It fs
AMMO
1a.
Ih
olAewrr(:n
M" ATCWA, 1{..
u<ft7 APO _
--- PRATE 'AL
�nyf .O•
f'LA TMatxee e,�
:.7�Y.BIi
M.
TO
ft.
ATRk1Ak
JRWIACFMANT MFI1101
4. Datu Wdi(s) completed: L % % /7 Welt 110#
Se. wed t.eeation:
Bt.t.eaci.th 1R 1.014rcyaf,2
FSIiIy/OwnwName 'rmdlity dye dfmplkabie)
Sine 1 C./NW A IS.,va$- Jel i'- Nei. pay"
tb)Tital Addams. City, aid%n
rCwrmy' / `
Panel ldaadduvknr Na. (PIN)
9h hadidde end leittitude in degNeWminutea/secoadn or dedsl degaas:
(ifwelt flew, One Wong isse&red/
34) Ott. /f5' N 611eef3
6. Wart) thewellhatemaneat or DTetddorary
7. is this a. repair* is exbddg well: °Vas or ofts
intic lsei m(a1r:d/tautivpwn me tenon:aloft infrnatiortmrdmeplmb 1h. larinrnllae
ra0mr under ?i21 wanks nano. on an rim kikefnlyfixm,
5. For Geoprobdbp.0 or 0ased-1.4op GeOtbcrmal Wells having die WOO
consaucloa slily I tiW-I is needed. Windt TOTALNUMBER of With
R. Toad welt depth eNortiaadSudete) (ft.)
Pc'areftsk wens £rsroildrpths iifketkrent (emnple• 3(g200rand 2MhM)
10. Static water level betow rap of come /1
If Water level is above caving use "u•"
11. Borehole diameter err (tn,)
a.
s.
R
JUN Friar
o,(wrnii0Pof Y""Pal i legt
22. Certif)andonl
‘Y.--/
Siamkan ofCerd0 wag""
Ina
/A s».Aat Ode fond t hareey titre Oar ate AHJ(r/ sae (veil/ coww#rarod in CIO
with 154ACaC OSC.age a• 15A AC,ACOW .O200 WWI Crannectior;n'aaavde an
cop y4(00More RollamzpmvidrdtnrMwl1AMwr.
23. Site diagram or additional well details:
Yon may wet bebk of grit page to provide additional well she details ,
ounsnuetion.details. Yon may shoadSudditionaipagaifrtocasaary,
rot. B1N[f (AL isimist now
245. &sj IYS: Submit Ibis farm within 30 days of completion c
dopsteaetion to the following;
131vbionof Water Resources, Inlbimattots Processing VI(t,
1617 MR &nice Center. Rald gh, NC 276991617
RECEIVED/N r In addrtiOI to sanding the form to the address
era, copy of Nis torn within 30 days of completion r
12. Web ec,ntioo method:consttacdon to the follow
OA ewer, wow. cok, divan p,sslr,aaeJ "g
FOR WATER Salt WSW ONLY)
JUN 76
Illidsha of Water Research, underground loam coati* Pews
1636 Mail Sereke (enter, Raleigh, NC 276994136
13a. Vidd (gpm) Method Oust: 24e. For Water Suva* & lair esooe Welts In addition to swdurg the p
Water Quai Fes) shwa visa suuhmit ono may of this teem within 30 4
Ob. DiefeQedoe cyan AthoYOR 0parmeiori of wag conahu:Wm to vie tower With detainment lie the
Warn ingtenlierrid'TCW '

i k pvi igiF
WELL CONSTRUCTION RECORD ( W—I)
I. Well Comas Information:
GiD Re Z AJC
Well Controo he
NC Well Coawuew Certification Number
A GL w /9u.y4as o Res t
Company NNE
2. Walt Capiotractnn Pernik 1:
Lir1 all "Rhea* well aenrlrurrien perms (La. CIM.. C+mnp. Shwa. FaAsema arc).
3 Well Uea (check wen use):
For internal ac only:
444536
room 'r0 ulavmrrWw
a e h.
3?
coats 1444
R.
R
+1'a'OUTER 'CASING Qdr'maltial d or 01'1.0113WIr
]I
FROM
Y`I R.
MAMMA
�0 ItI ti. �O1 o
•16J.'INNW'GY 4'DR
FROM
To
MATERIAL
MATERIAL
0.
RI
io.
0.
ft.
in.
Water Supply Well:
Ageioulmml QMutfwipalPublie
3GeoWermal (Heatiiig/Coeling Supply) ©Residential Water Supply (single)
�basalt/Commercial ©Residential Water Supply (shared)
iwiadoo.
on -Water Supply Well,
(Monitoring
niceties Wells
Mailer Recnmge
Aquifr Storage and Scanty
Aquifer Test
3Expertmental Meadow
�Gemhaomi (Closed Loop)
1Geothenoai (Nearhic/Codlln& Rdum)
®Recovery
Lja Omuedwater&mediation
OSdinity Barrier
©stormwater Drainage
DSubsidence.Control
QTaacer
:'bother (e, plain under al Remits/
4. Date Wdi(a) Completed:Sr' 9N ^11 WdIID#
Ss. Well Loudon:
C/ieJq SA,4€ tS
Paailiiy/OwnerName Feel% We (tfeppSmbie)
fibs /&1�'r'l'e LA) t3;(H ,ve.
Physical Addn�9M,, CO. and Zip
Calmly dotal *damidoodoa No, (PIN)
Sb. latitude and bngilade io degreeeSminutakcee edwai amen
(if well dela, cot lat/long idatSicienq
34° /neS"),N Oen°4Ne5at,••
6. bare) the well(a)OPtrmanent ar QTemparary
7. Is this a repair to an esbdog well: Qves or Elko
/f 1A1eoa repalp fat ma known well awntmedon Infonnmlan and explain tiro nature ofthe
repair under 111 +morns secllan or um the hack'OOAiefurm.
S. For Geoprot*DP1' er Glared -loop Geothermal Wens having the same
construction, only 1 GW1 is needed. Indica TOTAL NUMBER of wells
drilled.
9.Total rat depth below land surface: 31 - (ft.)
For multiple wells list ail dbpda WORM (example- S6200'aM4I001
IR State witer level below top dash* 1
',water level it anent outing. urc "+•"
IL Borehole diameter: Oa.)
12 Well romtructios method: t.o...1"e4w'
Oa. au{nr, Say. table, dime Puck, ae.)
(fc)
•
FROM
ap
R
0 n.
R
TO 4 OIAMEfl a WM =
0 0.
R
TRICRRMO
OKt
NATURAL
,
efilfLACERIEMI MLtHOP a stoma.
R
R.
83 To (IAA RDIAL dettlACrd/ENfM6190D
R
R
30;H CO : "•,,' "':'a::a,;:^`Tau,•
TOpt$O1RFAON Oar. badman W rora Om SSW* Oa
FROM
R
0.
R
B.
R
R
R
(s.
R.
R
R.
RECEIVED
JINN 2 2 2017
22. Certifies
siaa
al tram
I.nhfmali011 Proceesa+0 Unit
DWCdBDta
Seat'-n
Date
dy tlgnewelarfbew S hstvdvlmrljjy that Re walla) was (ware) constructed in aemrdaws
auk ISA ACAC 02C .0/00 I SA CAC 02C.0200 Well Conspgalfon sandante awl Met a
copy of this nand tar been envidedtothe wee owner.
23. Site Magna or additional wdl details:
You may use the back of this pogo to provide additional well she details or well
eossbucdon details. You may also attar* additional pages if accessary,
SUBM[ffAZJ STRUCTUONN
2d2. For All Was: Submit this form within 30 days of completion of well
construction to the following:
Division of Water flaunts, Reformation Rromaclne UnR
1617 Mail Service Cater, Stateigb, NC 27699-L617
24b. For lulec0on Weer hi addition to sending the form to the address in 24a
Pisan, duo eubmit one copy of this lore within 30 days of completion of wall
RECtIYtU/MC n following:
Divides of Water Raeosroes, Undergramd Injection Control Program.
A636 Mall Scram Center, Rath, NC 27699-1636
FOR WATER SUPPLY WELLS ONLY:
JUN 2 6 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD fGW-ll
1. Well cwdncler Inforoueinn:
G.o taty Tewe S
Well Cennactoklene
NC Well Contetr orCen n.:non Number
FI Qt,wt3 W'c•/1 Dad, :A]
Cowpony Mama {
2, Well Censtrucdrm Permit a:•
owl loll* wall construe:a tpene&(le. Mt Cowry. Alit Peon tea)
3. Wed Use (Meek well melt
For Internal Um Only:
444535
Lit
0 0 tL
IMOM
ft.
e.
R.
R
a.
WA
to
asa
to
In,
Water Supply WeN;
©Agriouilural f Muni ipel/Public
Dacotk nnsl (Headng/Coaing Supply) QRusidenttal Wskr Supply (single)
JhldustrialYCommemiat flltesidendai Water Supply (shared)
IT. •SCREEN
Ia1QM
�vtG
ft.
illtedaT
roan
a-
e.
Nen-Water Supply Well:
Monitories
Mien Web:
QQAquifbr Recharge
C3Aquifr Storage and Recovery
fpst AquilaTe
i3apelimental Technology
'lReaovery
©oroundwater Rave dietion
OSaiinity Barrier
Dstonnwtter Drainage
®IStdrsidatce Control
©tlsgdRanai (C7oadd loop) QtrPoxr
1Geo hadnal (IimtiM/Coonaft Miami f odta (mwlein undera2l Rena,
4. Mate Wend Completed'it 4 Y —' / • a Witt .
Ss. Wed Location:
SR ISaiyee
Fonlity/Uwnur Nome, fciliyila(iraualicobie)
// ° U4W4 P► De w:tru N Q.
Brent Meuse, Clffl tad lip 94101
A )all.) Nsv e.w—
Camty Pnd ldendgmlkm Na. (PTh
p M. do e.
R R.
meows ( Mw
pt.c
.„ ""�17aroyAM& An
5 f
n.
NtIM
& e.
MATILSlpt.
et U,RMeerI 6reflt
ab.•Ysdtade and Ini nude in degr'tea/adnoteshesonds or decimal degrees:
firma add, one taaenp•ie amEncht 0
34° /3,• rat N ba brior •
qy
4: Islam)the well(s)121Parmmcat or DTeraporary
`
•
7.1e t■teplttr town twitting wall: fYes
Ihdor Din
puns a Meer. fill out MS wed MOWIecrraa arpmrctrareeftlf 001 the eaten Oftke
repair wu4r at/ rstavM.aaarwn n.unthahat grtNrlone
LFor Geoprobel8PTorOs d.UepGeotbamdI Wallaby/ins die same
colattudion, only I GW-t b needed. Indicate TOTAL.NUb1,NSRof walla
dr led:.,_.....r....,.__.__-•--•---•
9. Toter wall dent' NMIow raad6darlate, 3$
Wr we/ I
"nun* k der
deelbr tedgewm
2
e.
R.
fir
h.
a.
, ft.
e.
ft
R
RFCEWE Li
JUN 2 2 Z017
.;URE
22. Ctrdamtlee:
SigseofC`a(iaed WeM/,nua
Cam
!ij atgnesa 41Is/etel. t het�vaarrpy drat the Gelpip v (wer4 fadonecad m am
wM ISA A'L'ACdre.otdoer ISA NOW RC .ozgo Wed OYMalnteffen Snare& an
copy Ptah record ha 6eea provide,' fa grave Panty.
23. Sire dingron or additional wall details:
'Yon may use efts back olthis pagepla to additional well silt details
tonsiruaion delails. Youmgy also attach additions! pages lftwatswy,
•$ul MfTAL Nqt pRUCIIONM
(emnrp/n Sgtaoo'aMS Itm7 ( 24s. For All Wefts Submit this grant within 30 days of completion
1.6. Matte waterievel Ink* fop of auks /a"
{twat level de above a'anbr,. ore •�.�. ••
11. Borehde diameter:
'12. Wog eaaairwedm method:
(i a, augur, rvtWry, one, (Oraoe pran, eto.)
eonslttaian to the felkwktg:
(k) omit* of Waer Raovrcm. foformatfon Proeeming Vole.
1617 Man Swijke Center; Rakish, NC 2709,d d17
24b. For Iateeston Wee In addition to sending the Porn to die address
RECEIVED/NCDENR/D� also submd ono rmpy of this Poml wittin 30 days of completion f
hncdonto the *flowing
TOR WATER SUPPLY WRIAS ONLY:
lam. Prod (gpm)
13b: )italgfetliga type:
Dtvldon of WaterRemdras, VadeTClrona4lo)eeflon Comm) Wolin
JUN 2 6 2017 IG3dMen Service Center, Rateih,Pie 2Td994d36
24e.'For Water Stunt & Inked*, Wdb: In addition to sending the
the addNoa(es) above, also tenant on copy of this form within 30 d
Amount: Water Duality Roei° gpmpladon or well construction to the county bnahh department of the
Opet eau ua Set.uot wk." met" ntod
Wilmington Regional Office
Melted oink:

WELL CONSTRUCTION RECORD (GW-11
1. Well Contractor tnformativa:
�7A le n-n.Ue.
Wall Con wue
9-/99
NC Well Contralto emigration Number
A &wM (Artfl _Div 11 aN Q
Campo:" Nemo
21 well Cooaaraedan permit#:
/.ur elf oppllooble wen dtnetnwli e. lumber Ica. UIC. Cawea.'9me• Vass= eta./
Well Uea (cbetk *ell use):
War Supply Weft:
Aptoamml EpMuntetpal/Poblte
Goland (WeSWgatiting Supply) °Residential Warr Supply (single)
indostriaUCommeltdal °Residential Water Supply ('tad)
an -Water Supply Welk
�Mmu'toting ©Revovmy
n)uRonWeft:
Aeaikr Reahlge
Aquifer St p ateand Recovery
Ayuife Teat
isxipaimenW Toohoology
�Csoothennal (Closed Tap)
Q}oroundwater Remedimion
f Satiniiy Berrien
Dammam Drainage
®subsideea Coated,
DTrater
nocothunal (eleatinarCoolims.Retvm) {Other fcaoiain under 921 It musks)
4. DM We9(f) Comptad: 6-1—/1 Will NV
Sa. Weft London:
rDc& »C»14 S
For Internet Lim ()niy:
444534
orii Frson
00 3r
h
a
A
cove 5".ata
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3 k.
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in,
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e mar sten
v h St tti
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oCt
cap t;d(Rfre ..,:.
0
1 TO A. ='#moo as
?Pat
.PROM
h
TO MATERIAL
A.
SMPUCaMENT MEa a1
FinakT/6ww some.
91a Wy&torwen
mood Addles,naty,and 7.0
Nett 4104m st+er
Facility ON (fiapngabk)
O�.aAvt
Camay Pam ldmanrneon No. {PIN)
SA.katatlennd kagitude to degreahminuteataeconde or darnel degree*
(&welt IWIa. oat Wong is sufficing)
31,52- So N 077 O
6. blare) the wdl(t)114Peraanent or f remporaty
7.1s this • repair to to misting well: Cites , or DNn
nix ha ramie flit m/tatlotra, welt enttawatan lnfom;Orma s Worn /du aamreoflhe
owner wddr u21 rmaaraaaeraim or Da lha hcta• of.MYJam.
St For Geoptabe Dfl or Qpsed-coop Gcotlirrmal wefts having the same
ea lftiatimt.W>,v 1 QW-I ismaied. IndicalTOTAL NIMBI%dab
drllkd' _
9. Taal wdl depth tddw'.kadatria: 3 ( (R,)
PemMtaple web Woe *pas ifdame exempla. 31,200'aM2631001
IA Shoe water level below tap orao)og• / 3--
If %weft Wel t above owlag one "0"
tI.Borehole diameter (0 011.)
32. Well eomerac'doti method:
(D0. avOnr, rotary, alb* d'eart OAS.)
FOR WATER SIMPLY WET. $ ONLY,
13e. Vdd (OS Method of test:
13b. Dlirfeedoa type: Amount: .
Ft)
a
a.
MNemjaWme dosltan14e.
A.
• rL
th
n
tL
R.
ti
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9.
RECEIVED -
JUN 2 2 2017
DWQ/t$OG
22. Certifications
6 —17
SegMlureofQuad �Well coa cior Date
d am
with oflalfey Ike the !
r ISA (CAC .02 tli Cnornoen mtenty wi
dopy older ho bkatprovtabs(oale well moat.
23. Slkdiagrin dr Addlfedsl wdl details
S'tw msy owe diobaek or fhb page t0'pmvide additional weft site details
cons, u ion detail. You may also adteddadditiond pages ifoccessary.
$YURMrfrAL lUICTIONS
2da. For AR Was Submit this. romt'within 30 days or ampfiiat
.coasoaton to the Mowing;
otalke o(Wekr Resoerces,.asbnnatied Proresiag Uair.
t617 Mali Senia Cater. Raleigh. NC 27699.16a.7
2eh For joiecaon' Weill: in addition to sending the ream to the address
chow, also submit one copy of this form within 36 des of camplelion
construction to the ibllowing:
RECEIVED/N CD Elinattwatereksoarte'a, Uadetgrdand lejation Control' Prom':
1636 Mail Serrlce Center, Reath, NC 27699•tab
JUN 2 ( 22gqpp,�pria eraoolo &Inleetbm Welk: In addition to sending Ufa 1
tliNdddMagos) abnto ea submit ono copy of this Fate within 30 d
coniptadon Of weU Waaaac'bon to the eomny lath department of me
whore mmmrw.rod
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-fl
1. Well Conflacter Information:
SO ge.4 MO aim
Wen Confl Mlame
NC Well (amneetorCongdon 'Plumber
A Q,.A n e tTeyyl 1224 Lb..v
Wmpany Nano - l
2, Well Construction Permit d:
l.la 011Pp rllcaNk wd/em rd.wirur par+ntr# (Le. UM Cowry, stela rodwra , derV
3. Weil list (cheek well use):
Water Supply Wen:
eAgricaltdml Municipal/pnblie
Oeotbemtel (IeeatingCoobhg Supply) 8Residennal Water Supply (single)
]rndustrialentunen:lai [ Residential Wafer Supply (shared)
::atee.SuppI, Welk
tcd
onimsinng$
on Well:
gfWr Recharge
quifer Storage end•Recovery
JA9nibm Test
©fixperhnental Testa olopy
7ticalbennd (Closed Loop)
"Geothermal (t ieadnp/Caoliva. Return)
4. Data Wdl(a) Completed: l)
See. Well Leaden:
©may
f Groundwater Retnedistion
f sdinity Farrier
Cistornmater Drainage
Qe.s�S.o_bsideoae Control
llifater(mtolain under al Remiks)
^/7 V1DIDa
fasiltri)awwName, - smithy a(itaiplteeble)
69 n fah-OQ.,LbNA. as1/44,9
Physical Address, Ciy, sad7,ip
Y Arch`
Colony
?seed reeaNawnon Nw (PIN)
Sk latitude and lassitude in'degedm)nuteslaeands or decimal degrees:
lifwod Md, etre Wens is suUieioo0
.311 6/0,,$"r9 N 077eSLr133r w
6.Ware) the well(a!> enent err OTehnperon
7. Is this a repair to an eating well' QVes or paw
yak in raµrir, IIIwtrlpreaw ivel a6nerl nietr it amnl rten �idep_torte die won erne
raaan Made cal remaasmum or on iho haver *fink Arm
S. For GtoprollelD T or Closed -Loop Geothermal Wells holm the same
c009me01io0r only 1 Get-1 is needed, Udimte'VOFALNU,MD.ER of wells
drilled: 9. Toter well depth hdotr.landaurtteet —et (114
FOP MI Mld welly NataUl eta (144Rrent (?ampler soar tia4wanq
10. Smile water keel below top of may
Orator leoel is chow andng. ase u.r
i Warangal. diameter: Co (use.)
12, Well tnnantedoa method:
(i.d auger. ratify, cab e, OD* push. era.)
Ircet_71,^ W
(1
FOR WATER SUPPLY W8b1 SONt.Vs
13a. Vida (gpm) Method attest:
13b.Disiafectiou type: Amount:
For intataa(Usorf 4:4 5 3 3
414
10 .4t •
ewers _TA 4,
iler 04aM61TR TwICa MATEWAL
$.j IL 90 ii. j a.. if. OILO I t/
warm TO et TM:WM el =UAL
m,
7
ft.
f1.
ATERIAL
SMP1A steNTMa7anf
ft.
f6
Zit
ID
to It.
tedara aaaREF aaaa!enspl.ake
R
R.
ft.
R.
RECEIV
t
IIIN irrlarr
-TFREKASKIS,
22. Cmt)D®doa:
Sigmmm often -g Icon
BYO t 7
use
By sfgaodar font, My Mu dad de wend was Ofere)coosotomf of arc
B 7ANCACO2C.• .,orF.LINCAC NC .11200•NcNCwalnwlam Pan& en
copy dais door d hm' h fe s pla f ided to the well m mer,
23, Sjeedingtam et IIddltlpgalwell detail.:
You may use rho back of this page to rookie additional well site emits :
construction details. Van may alto•anadtadditionalpages ifne essary,
24a, Ror AS Wdigs Submit this form within 30 days of completion
donmyetton to the following:
veson of Water Resources, Infdrmetien ?meanies Unit,
1617 blan&Mee Canter. Raleigh, NC 27691-1617
24k Fdr 1nleedon _We& In oddities) to sending the fbnn to the Mdasss
above, also submit one Ei ®}1ONNIIl vrI r. of completion
eonsWdfon to thetellowing:
B)vldop of Water Remoras, Undetgonnd wj bI�njection Control Pregrt
1626 Mail st 7' NC 27699-I636
24e. For WatLS*Dell_r dtlntadou Wok: In addition to sanding Mg 1
the eddreas(as} above ako. submit one copy of this tom WUbin 30 d
completion of well crsaMtGuhtttgollagtheinh department or the •
aaaww 010150001,01 Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-11
1. Weil Consoler Information:
+
Wolf C011neabiens
?%)9rt
rat well Cmdralor Cenifcauon aloft
A a.is e% LATt1/1 O2.1(,.1/4,2
Ccmpnny Name
2, Wes Constructing Pertn(t W:
For Inmmat Use Only:4 4 4 5 3 2
I
Ey
rear
r'�-
a O R SO N. C4n, Sac
e
• re. R,
tin all applicable wall moneumovke permits Aw VIJCC C
3. Wed Us a (check well tee):
ty. .s1a Porn mac No/
ft
1j OUTERCASINO. the milk ailed•gdyl0kUIN®R3$b'a Sa—):
4
J.b Rj b.
AVRASINGieattreRlle i.
ri.
m
n4
TntarMad MatmAL
01(O
u'L
L
ft.
la
Water Supply Well:
(„' Agrio erase QManicipal/pobno
' fCkothenal(ifa$ng/CLotiagSupply) QResidentfal WaldSupplydingle)
43indmtriaLC'ommercial f Residendal Waltr Supply (stewed)
Noon -Water Supply Well:
Monitoring
1a)acgon Wdt:
'Jammu
AquifaRee)sarge QdronndwderRamedimion
jAftelar Stomp and Recovery ()Salinity Barrier
naquifer QStomavate,Drainage
frjfxperinaanal Terhaologa . QSab'side= Control
D mdt:Rnat (Clime Tapp) CMS
` acrnhmaal (Ratne/Cootnf.Return) nete(eaobin ander621 Rentedrsl
taste Wdl(s) Completed: 4"".0-/ 7 Weu me
$.. Wed Lecsdont
Pearl nerP Woad titappatabte)
e1 tout W.tfh lUe aSa4o/
Physical. Address, Ced, rse tip
•LJCac) Mioswr
Canty Pared IdmtUMdmNa MN)
Sb Latitude mithi glttade fn de rn 1Snulnl,aeenib or decinhnldegreee:
Orme! field, me Won israalatoal)
31, ° /4 • /at. N O'n o - 012
6. Ware) dmwcll(a)4Grehmaneat or QTcmporary
7. Is this a repair to an mirtl%gwelt QYes man
r,.ah, r. r]1 ti�mari.* ao, xr ndm Aveklow blown well q 7M.mdprpkl'In lhr aawnrolNr
k dor GeOptobet3Ff or Closed -Loop Geu4bcn sl Welk; Mobs Meares
construction. only 1 C W-1 is dttokd, indicate TOTALNUMBER df welb
drilled: -.- , �7
9. rotate/di depth Mow bud same: . ?
For &NUNN: werlr lur art deeds gdO)nme tammpk• 3Cr p200' old 20001
lit Sock water Wei WOW top Meaty
rimer laud tv above easing doe "•,, /
11. Borehole diameter: Co . (In.)
12. Well aMRumioa method(
(i.a agary scary; ruble, dkwel pia eta)
(R.)
(feat
FOR WATER SIMPLY WELLS ONLY:
Undated (gpia) Method Otero
13% Redid -endow hype AwOline
17, SGRBON
PROM
aver.
m
3e
+k
in•
O/a
Naffs
Wee
MAItI
k.
n.
in.
note xo MA'lag1M. rWWfieraL iBOn1
a: rL
a
moStiadddlegat
FROM . 70
rs.
r4
MAC
a
mwnee boa
aa6
nu
ft.
A.
RFURVifir
R
R
nl
JUN
2 2 zuit
JRtorwpt n Processin$Un)t
22. Ceedicaaaa:
dIA
Simonet, P�al,'.Cdr�galor
eti
win 2MR 11CACOTC. f ISA Afft (VC NIONV N Wtaa vs web Swam& an
dopy differs reatdAia (tan provide iwn%cwrltamrar.
23. Site *arum or addid'd's' wdl detain
You may We the bad: of this pogo to provide additional wall site details
coilevaedon details. You may oleo alteMaddilienal'pages ifnmessary.
$UBMEF ALINSTRUCI'IOTIN
24a. Par AN Wear Submit this form within 30 days of completion l
aoadht:Mime to duo following:
ammo atwitter teemorcea. faierreatfon Prllcaekng fffR.
1617 Mall Service Center- Raleigh NC 27699-I617
Mt.. For Intention Wend la addition to sanding the form m the address
Wow,construction
oast . also submit one fi,gpi�oIarrepekgt,)ity q T s of completion l
constructionmihefoilo 1YCU�/1iTh000t1lill r.
t7
ote plate
Melon of Water Bnouras, Dade ad Iafoclioa Control WW1
1636 Mail nerd eVgiv, 1)�(ai7b'iv�
lac. )far Water Sloss & dikefloe « +- ila'bdpMo sending dip P
We eddens(a) abaye. also submit ono copy of this form within 30 d
campietca of we:1i anartnreliam Utrhe conoty gram depetanent of the
here nnanmamn ater Livality regional
Operations Section
Wilmington Regional Office

WELL COIVSTRLICTiOKRECORD (GW-1)
t•Welltosteseter Information:
O,iYj4 fo S'
Wen Commele aene
NC Wdl Coal duo' Unification Men(
AGL.,r) (. sit O9sJ1 ,tom
l,'ampw y Kam
2. Wa11 ekns(ryctiea termer lir
for rif opaatAle wde crwrornmarMnervnrtf At. UK Camay. Slate, nut. x en./
3. Weli Vat (cheek Well use):
For Internal Use Only: 4 4 5 31
•:M.wATER ..:, ;,.. ..
Pepsi rumor
oW
cesl6is SA,A.,
to enli RLameatadSWk Waal
6
MINIM OR
MOM
a.
TO
° MaTan
3-
ice.
la.
rntctr vps
oei
aanac.YBa
•
Baal.
pJ tL
MAiantAL
fL
water Supply Went
Agrieubural QMunieipalArobnc
Geothermal (Heating/Cooling Supply) f Reidlauiat Water Supply (singio)
,Indrehrial/Cunanerelat OResidendal Water Supply{shared)
Non -Water Supply Went
Monitoring
6jetoa W -1:
Aquifer Recharge
OAguifei Storage clad Recovery
jApuikrTet
&legab s:sea Technology
Geothermal (Closed reap)
"lOcott mnal(Hemine/CoogesRama)
atemvey
©Groundwater Rcwedialioe
Salinity Barrier
Deanne
()Subsidence Gaol
Q Iaxr
nailer (captain rootletd21 Rtmietr
4. Oats Welled completed: L,%Y /I wen myse
Si. Well Loendon:
111000l9, r/,¢1/# Libelma/a
Agility/OpnaName Nullity Oft (itetgliwbie)
nee I S'bt isA net )- R1 t,•i try 't.ie. 02e4o4
Stele& Addteav, Chyme 74p
t Iwo / l,ei`
Corms Parcel idonaawrhm Ka OW,
'L Shade and lwidtude in degreWminuteareeeends or dedmal agrees:
Orwell dale, oft iaolong is tufawievo
3 o) ot.!. /f t N 677e'S3 , late:
ry' w
6.Igarcjthewell(s)mmhtteat or rjrnaitiorar0
7. fa Ws n repair to an existing well: fivers.. or owe
/Su lao repay. "tgiulh, "taw/me weln atnrsbnrlryotmmkealydeapMPo lheamert Aram
repair under 621 wme,kse.won .aw the me* pflhtehrns.
L For GtoprohrfOrt or posed -Woo Geothermal Wells having the sane
cmisnuatmi,only 1 GW-t intended. indicate TOTAL N13M8BRdwells
dripeel:,,-,Y-r,._..„•,..,._,,,,..,.„,...,.,._
9. Totai welt depth Pilo* tadd•dardaoe:
NarnWroir wear Ilsread/ptas Vdarent (emmph% giver and moo
I0. Stage water level below top of wimp 17
Meow Intl t3 above ming an °t "
11. Borehole diameter. in
12. Well cOnstraedon Method: i5 * ansimr
(tF, auger, notary, cable, direct piab,, 1e.)
(Rd
FOR WATER SIWPLY WELLS ENJLYr
13a. [field (gpm) Mottled of test:.
1'36. ma.fvc ton type: Amount:
17.301Fare.
PROM IV 'Warn
90 a.
a.
1.
la.
Slur/LEE 7arr,•alrms
WO 0 46
Mannta
re.
JUN'22 Z017
t' P rt.M fl . Unit
4),*-"-)
Date
By *Mg this fro. I he edr tartar amr the well@ Kat (see) crnsparard In am
with I24 sac m2Cson m IM Bogs; WC'.alpo Weil C nontenw•mmrirnes ter
nor4ratlr record At Been prlWMrdar Mews 'f motor.
23, Site diagram or additional well datalb:
Yon mm use the beet of thb page to provide Mdhlone( wail site details .
eanstructikn.delalls. You may aboattadt edditionelpagns memory.
,SB®MttrAL1143121/ TIONS
244. Fdr A11 Wear; Submit Ibis Went within 30 days of completion r
eoasbubdon to the following:
DMsioaof Wear lteoorces, Iotdiinauow Processing Gnat,
1617 Mali Service Center, Raleigh, NC27699-I611
14h Far isms m Wens: In addition to sending .the form to the address
nevem also submit one eats of this Nan whine 30 days Of completion t
construction toil.D/RPD NR Drp
Bittern of Wow urges, �n tojemiuo Control Primo
R636 Mall *Ma Center, Rakish, NC27699-t636
24e. par wtxc_suoutU$l4ei e�In addition te setufug the
the addass(es) shave, ersso's of rots Wan wattle 30 d
completion of well cansbumfon to the coopty With depamnent of Mr i
when. rnokIrOo M
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTIQNIRECOR» (GW..Q
,. Well Contractor Information:
GAWey .Tn.x
Well CwMt3tto
NC Well Caanadre CenifiratheNumber
Aa"i uotil Dealt,..,
Canpmy Nemo
2. Well Canatrdettn remit lb
LAr ep,yrprkv$la wall (anaraU'nw pitman (ae. WC, C'w s Seta, Aerfm,ca We)
3. Well Vet (cheek well use):
Water Supply' Wed:
aAgrlcuhural °Municip&/P iblio
Ga thednal (Ffeetprg/Cooting Supply) °Residential Wear Supply (single)
QindtatialrCommeretel f ReSidtmUM Water Supply (shared)
Mee -Water supply Well:
Matitoriag
egos *al:
.3Aguiffer Railer
,DAquift Storage and Recovery
)Agnilla Test
°Racewaty
°Groundwater Iteinedisiien
°Salinity Harrier
Opein waterDtain g9
Daspatimental Technology f Subsidenet Cored
©Ciaodrannai fated Lapp) °Trace
10aothe*mef (Heatna/Cuol ntg t(duo) fodta Mantle under #21 Renege/
4. Data WdW) Can:plated: 6-1r/7
St. Well Welton:
R4, w� %M-tr+e G (
rsi1lMCTmerWas
3a-n 42U. r s Lou .
Physical Address, City, and lab
Nab" Ey7ln.00-
Wen IDO
Aaolfiy IDI.QrapatahIe)
tei.Le, AJC a-TYo4
County SUS tdwti&ratan Na (PIN)
Sh tabula sad bagiet lle in degreeeratnershemnfls of *dash degrees:
(instil field, cm Iatloog is as iclent)
3Y ° O ti a 13TeN 0')9 ° f4a 66'C
6, Mare) the wan(s)dPermanent
or OTemporary
7. lathta■ repairto en nint%well: tiVeS r16,40
"Mists a ,apaln,fill edrbroww wedanrcdfnlor rnAreiarlar end etpbinMMNnanrra ofals'
repot awoke MN rav,vrkraawiwe wen dn:tivekepadaJana
8. Nor Geopr:he/0Fr or Glared -La p Geothermal We* hewing Me Sane
cmutmdion, otdy 1 GW-I iS Waled. 10621e 'tOTALNU MgI of Valle
drilled'. a
9. Totil wall depth below .(ehdsurface: 4f!
forsiwme wells flea thighs (/ddlirnu(emmppfo- mufti' end 2r oo1
18. Shade oar fevei below top of maims P%
(%v4falevel trah0va ccsing ado _a"
11.13o►ebole diameter:
12. Well eopotruedoo method:
in)
(ft•)
(tie arm relay, Ste, direct ewkaa)
FOR WATER SEPPLY WE/ S MUM
Me. Meld (gpm)
1'3e. Dsssoteetioa typo
Method of met:
Amounts
For internal Use ()My:
G
444530
.l�vsi4,FERSONER. . .
rMal asaC rrr fn `
yr " caw- siCr
h
h [L
n.
A.
• JUN 212.2017
a
n
DWQ/110G
22. CatlGcniloan
Sigmas of WPieter
Ost
aY VOW r*SSAM •�.. 1'te it OW.* SO was Caned cenauiumd in as
wW, ISANCACO2C4100er FM CAC OE(f,0200 OW1Cmw,nwrkw Smart en
coprofdtrmodaas Oe0npov 4wte*SIo an
a Site dlagnm dr addldojm wall detain
You cm use the beck of Me page to provide additional well she details •
coSs1s4on details. You stay also at addigortatpaps ifneassery.
gEMMIITALINSFIttlEMONS
24a. For An Wilts: Submit this Esau within 30 days of completion r
dovsfdatontothe following: ggfryD��
.
Maim
1600 0tfls�#irCrw tneeaefng flhft.
27699-16t7
24b. ,Errs lnfe tine Wigs In addition to sanding the fern o the address
above, also submit one mpytIZfarmmg7p 30 days id COmpletiOn h
eonatntaimttethefallowing'U' I
DMSnOfWatrRsigdol9Iton Control'Pragn
1636 MC 376994436
2Aa Fee W*er �sg(yi 0 era ion chi n
l M to sending tic 1
the addteel ea) More, 10 a o IS form within 30 d
completion of well consouction to rho county health deputised of the
,Mann rnns fenM

AQUA WELL DRILLING
Gar lanes, Owner 1706 Kennedy Road Wilmington, N.C. 28409
Phone 91O 395-1987 Fat 910313-3102 - AauawelldriWM Ibefsouth.net
Date: 5 - F 1'7
From: Gary Jones
To: NC Water Quality Groundwater
Phone# [phone]
Fax# [phone]
RECEIVED/NCDENR/DWR
JUN 2 6 2017
Water Quality Regional
Wilmingtoon Regional Office
'IA Pages Faxed includes cover sheet

WELL CONSTRUCTION RECORD (GW=11
1.. Weft Contractor Information:
G,ogat Mlles
Well Coanabf ne
01)99
NC Well Contractor Onta on Nut
A Q,Aan wt/l
Caap1tw Nero l
Z, Well Comtruction Permit f:
Naafi aryd7aahla avll ennxrvabmµrmits (Au. WC Come%. San. radar rig
3. Well Use fault well W);
Water Sop* Well:
aApriauhnal QMonioipawwnble
aQeolhbmal Otearing/tao(tng SuppIY) °Residential Water Snooty(single)
JMdustrial/Commenhxl °Residendd Water Supply (shared)
Non -Water Sappy Wdl:
Methanol f Romvery
Well:
©Aquifer Recharge
°Suit' Strap and Recovery
°Aquifer Test
Qfsxperfnlental Teehrofogy
f Qeodtamal Montt loop)
"Geothermal (Redfna/Coolino Return)
Domandwater Rdnedidion
°Salinity Barrier
Montan* DOS.
QSabsidn CCOMT01
MUM
nether (explain under al Reindict)
4. Date Wdl(i) Completed: infer? Well M it
se. wen London:
R(,qcry %f,-No.
ran ninth
.3 -, G,.);tc fz. S-7.
Phreio) Addms, Lt ad 740
Ants, 1474%oor
Comfy pared taadacdtw Not (PIN)
PS' IDA (lfspdheble)
Lr. colt. Mt ni/O4
3b: Latitude and Ieagiade la degraN ohnter ecconde of dednwl'degrees
(If wall field, one Ifedag is wflielenl)
2'a° O4(13fl ern ° c,l,16Z w
6. Ware) the welRaldPermaneoe or DTefdrporory
7.Ia taigarcpdr toaa ealedng.wdI: °vaer eireo
edit tsa twsdr lx(wl,Mowa welrbwmflaaair afbrm,mIn Ord COMM the naeteof fie
Pepe wain' f91 rraamb.mafw, of an lhebuNtgft lafrnn.
Saar Geopf obetDf .t` or Gosed.LeopGeothermal Weitshaviog'tae same
constradien: only l OW-t boarded, Indict TOTAL)VUhflM3R of wells
tltnled:
9. Total well depth below. rand iodate: er,
potnolilyle walk /Sirraildepths idgfrost (ermna/a-'aad�gzdo'aad2@rap,
I0. Sada wsar level below tap of eaingc.
Jfliate had lsahorrWOO WO r..
Borehole diameter:
12. Well eoodn(edoa method:
(Le auger, rotary, ebb, direct pub, at)
in )
Ct)r4aar
(Rd
(tt4
FOR WATER St.(l4LY WELLS ONLY:
as. Yield rpm) Method of teat:
(3b. Dlsfateedna type: Amount:
For internal Use Only:
44452,9
4•
A, ft,
to
V8' ' cceArs yA-4
D.
IS. MIMICASINC(far •GRVBR•aftesollearde •
PROM ( TO F n4Mt . mICKRans 1 MA'rbl
(t.
h
Ill
tyt ft.
10
ft.
r.
MATERIAL
raOte
Vo"
TO
re, .n, at,
w
mar
iw
Ff M ` rMifnux'I 1,1'
o4# J PJ.,t 4t Coy'
0
O.
MOW,
D. n.
IMetenter IKano!
ft. 0.
To
0.
a.
a.
a,
fmweaWeese 'legnyaewara
a.
a
a.
R RFCEiVED
It.
0. 0. it+n Procesoirf9 Unfit
'^aL,'RCMtfc•.)flto(1a4y.,....,lnm
22. Cerf)Bcssoa:
"/.f =)"
sigJ rc of Red tY meow 19aS
Sr Aran (NM Ant may twrdy rhattit eras) RRr fry i tansawd in am
wera ISA NCAC 02C.Orda or 194 NCAC 02T' .0360 NW CorotivaNa Stonabr*A•on
copyo/tmr;seteSIra Aug pmrMedeemtwcgmina.
O
23. Me diagram dr
WR
You rep' win the ba titp to'pmv Rnotional well site details
eortsbudioadedls. Yon natty also attedfadditioaatpag itneoessery,
,iglrllMflt .f 'RUeI3 2 6 2017
24ft par Alt Wrxe Submit This form within 30 days of completion c
Contention to dos folb
alter Quality Regional
Melon ofWsoBrattineftfr.i liti nereceaoingUgh.
1617SIVIdee:irtg(dtrRSgiRxllifti tRp27499•1fir
24it. For Inleedon Webb In addition to sending. the form te the address
abnv; also submit ona copy of this form within 30 days of completion f
IWnslnrdioa to the following:
Division of Water Reeenrces,budatrolnd Nett Control Trott
163d Mod Service Center, Raleigh, iyC27699.1636
2de.. For Waft di Median Wes: In Wain te sending the f
the address(es) above, also subedit arm COPY of this form wihin 30 d
eumpledon of well construction to the caunry health department of the
wiwm an rind

WELL ONST1tUCTJONRECORO (GW-!)
I. Well Contractor Information:
Well Contrattaleme
For Internal Use Only:
g c� p too l to
I. 11. cons sitaiok.
Net Wan Mnlrtmat(Aelflerainn Numbs i
RECEIVED/NCDENR/DWR
JUN 2 6 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

tt, vAF
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
John Salmon
Well Contractor Name
3497-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (Le. UIC, County, State, Varian
3. Well Use (check well use):
N/A
to)
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Xf Irrigation
DMunicipal/Public
DResidential Water Supply (single)
Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothemtal (Closed Loop)
Geothermal (Heating/Cooling Retum)
DRecovery
Groundwater Remediation
QSalinity Barrier
DStormwater Drainage
Subsidence Control
°Tracer
(Other (explain under #21 Remarks)
4. Date Well(s) Completed: 5/17/17
5a. Well Location:
Scott Bower
Facility/Owner Name
1117 Upper Reach Drive,
WeII ID# N/A
NIA
Facility ITO (if applicable)
Wilmington, NC 28409
Physical Address, City, and Zip
New Hanover
R06608-015-006-0000
Camay Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 119 2015 N 77 528 4332
w
6. Is(are) the well(s)&Permanent or E3Temporary
7. Is this a repair to an existing well: DYes or xONo
If this is a repair, fill out known well construction Information and explain the nature of the
repair under 121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is. needed. Indicate TOTAL NUMBER of wells
drilled: I
9. Total well depth below land surface: 1 56
For multiple wells list all depths ifdifferent (example- 3®200' and 2©100')
10. Static water level below top of casing: 5 (ft.)
If water level is above casing use " "
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: Mud Rotary
(ft)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 1 00 Method of test: Airlift
0
136. Disinfectioq type: HTH Amount: 3 /o@10g
Print Form
For Internal Use Only:
444348
14: WATER ZONES _
FROM
TO
DESCRIPTION
ft
ft.
{t
1S. OUTER CASING(for multi -cased wells) ORLINER (ifap Reable)
FROM TO
DIAMETER
THICKNESS MATERIAL
0 ft- 90 H•
4 in-
SCH40 PVC
16. INNER CASING OR TUBING (geothermal elosed-loop
FROM TO
DIAMETER
THICKNESS
MATERIAL
90 ft- 140 ft
2 in.
SCH40
PVC
ft R
in.
17..SCREEN -..
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
140 R•
160 ft•
2 in-
.010
SCH40
PVC
rt.
fG
in.
1&GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
20 ft
Bentonite
Poured
ft
ft
ft
R-
19: SAND/GRAVEL
PACK
(if applicable) '.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft
ft
ft
ft
20. DRILLING
LOG (attach
additional sheets ifnecessary)
FROM
TO
DESCRIPTION (color,hardness. eoiVrock type, grain size, etc.)
0 ft.
60 ft.
Coarse sand
60 L
105 R•
Hard limestone
105 ft
135 it
Sand and clay mudrock
135 ft
160 R
Sandstone
ft
ft
ft
fLr
�F
ft
ft
31.REMARKS'.
Intorr,sa(iOff ?roc "I's s.1 U`AI
r.anMSrC?i 41
22. Certifca (oo•
fied Well Contractor
signing this form. I hereby certify
with 15A NCAC 02C .0100 or 15A N
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of' this page to atg allt124ly ll site details or well
construction details. You may also attach additions pages if necessary.
SUBMITTAL INSTRUCTIONS Water Quality Regional
24a. For All Wells: Submit this fox pictitIAl3e completion of well
construction to the following: Wilmington Regional Office
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sn➢nly & Iniection Wells: In addition to sending the form. to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
05/17/17
Date
reRn4muctcd in accordance
llf7 f4b0lYRdards and that a
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD
This form cm be used for single or multiple wells
1. Well Contractor Information:
Bryan L Vest
Well ContactorName
3580-A
NC Wen Contractor Certification Number
Ranier Environmental Drilling Inc
Company Name
2. Well Construction Permit #:
Mt all applicable well permits (ie. County, State. Variance, Infection, etc)
3. Well Use (cheek well me):
Water Supply Weft:
°Agricultural
°Geothermal (Heating/Cooling Supply)
o Industrial/Commercial
o Irrigation
DMunicipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring °Recovery
Injection Well:
°Aquifer Recharge
°Aquifer Storage and Recovery
°Aquifer Test
°E7perimental Technology
°Geothermal (Closed Loop)
°Geothermal (Heating/Cooling Rearm)
OGroundwata Remediation
°Salinity Barrier
DStormvmter Drainage
°Subsidence Control
°Tracer
°Other (explain under #21 Remarks)
4. Date wefi(s) completed: 5/3/2017 Well w# MW-47
Sa. Well Location:
(former) Crown NC-733 NCDENR # 15466
Facility/Owu&Name Finality IDit (if applicable)
2545 Castle Hayne Road, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
County Pored Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifweg field one tat/long is sufficient)
34 17 17 N 77 55 20
6. Is (are) the walks): ®Permanent or °Temporary
7. Is this a repair to an eddinpwelt DYes or BNo
inks isarepair, fill out bnmv i well comtrartion information and explain the nature ofthe
repair rarer 021 remarks section or on the back afthis form.
S. Number of wens constructed:
Formduple injection or non -water supply wells ONLY with Ike same amSur, you can
submit one form
9. Total well depth below land surface: 40
For multiple wells list all depths 'different (rumple- 3@200' and441001
10. Static water level below top of casing: -. (R.)
"water level D above casing use "+"
11. Borehole diameter. 8 (la.)
12. Well construction method: hollow stem auger
(ie. anger, rotary, cable, (Wed pmh, de.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test•.
13b. Disinfection type: Amount:
For Internal Use ONLY:
414101
14:WAVER :ZONES
PROM
TO
DESCRIPTION
ft
mar
ft.
R
15: OUTER CASING (for
®Id a W wale) Oft (if a Nis)
FROM
TO
DIAMETER
THICKNESS MATERIAL
NA O.
R
m
I
14 INNER CASING OR TUBING
toughened deed -temp)
PROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ea
35 R-
2 in.
SCH 40
PVC
fL
R
h.
17'SCREEN
PROM
TO
IDAMETER
SLOT SIZE
THICKNESS
MATERMAL.
35
40 R'
2. m'
0.010
SCH 40
PVC
R
R
in.
7t:GROUr
PROM
TO
MATERIAL.
MIQIACEallpef METHOD & AMOUNT.
0 K
30 R
Cement
Pour
30 E
33 R-
Bentonite
Pour
re
I.
19. SAND/GRAVEL
PACK
(ifapplicable)
IMOM
TO
MATERIAL.
EMPLACEMENT MECUM
33 ft
40 rt
#3 Gravel Pack
Pour
R
R
2e DRILLING
LOG (attach
Madan.) sheen tfnnmaary)
FROM
TO
DEStH1P ION Oder, hardens, saanrk type, ear Me. ter.)
0 "
1 mac
Gravel
1 a
4 R-
Broom fine sand
4 rt
11 R-
Brown/black Gay
11 a
28 e'
Light tan fine sand (saturated)
28 n
40 n
Tan medium/course sand
R.
ft.ft.
PFCL
1� 0)
fc
21.RFATARKS IIU N
0 Z Oj
Finished with flush mount cove
in(o cation Procer*tli()c;
22. Certification:
s_an- L 14tst
D4"vOh3Ch
5/5/2017
Signature oF4adfidWdl Contactor Date
By signing this farm I hereby certify that Ike well(e) was (w ) Imcted m accordance
with ISA .NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and theta
awry of this record his been provided to the well owner.
23. Site diagram or additional well details:
You may use The back of ibis page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SURMIITAL INSTUCTIONS
24a. For All Was: Submit this form within 30 days of completion of well
construction to the following:
Division of WaterResources, Information Processing Unit,
1617 Mail Service Center,
us1�la�lleleii�gjhT,//pNptCry�22ry76s911I9-1`/6T1��7����p
24h. Far )nbxsion Walla ONLY: the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following: �I�I �In1s�' yy � ��7t�i7
Division of Water Resources, Undes{PokLdIajeet&D antral Program,
1636 Mal Service Ceuta, Raleigh, NC 27699-1636
24e. For Water Supply& Injection veneer Quality Re i nal
Also submit one copy of this form wile non of
well construction to the county hei(pp% ei&t Ceere
constructed. Wh
Form OW-1
Nadi Carebma Department ofEnvi mment
and Natural Resources —Division of Water Resoaas
Revised August 20I3

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Cotnpany Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
fllrrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
IAquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 5/1 1 /17
5a. Well Location:
()Municipa1/Public
()Residential Water Supply (single)
()Residential Water Supply (shared)
()Recovery
()Groundwater Remediation
()Salinity Barrier
()Stormwater Drainage
()Subsidence Control
()Tracer
()Other (explain under #21 Remarks)
well m# NIA
Scott Estrich N/A
Facility/Owner Name Facility 1DT (if applicable)
409 McQuillan Road, Wilmington, NC 28412
Physical Address, City, and Zip
New Hanover R082170060140000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one tat/long is sufficient)
34 05 01.09 N 77 54 20.17
w
6. Is(are) the well(s)jX Permanent or ()Temporary
7. Is this a repair to an existing well: DYes or xONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1,21 remarks section or an the back afthis farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:5
9. Total well depth below land surface: 140
For multiple wells list all depths if different (example- 3(200' and 2@1001)
(ft.)
10. Static water level below top of casing: 17 (ft.)
If water level is above casing, use '4" y
11. Borehole diameter: 0-20/8i' 20/C�4 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, Etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100 Method of test. Airlift
HTH
0
136. Disinfection type: Amount: 3 /o@10g
For Internal Use Only:
4441(i2
14 WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
fL
fL
15.:OUTER
CASING (for
multi -cased wells) OR LINER (if tip Ecable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 fL
95 ft
4 in•
SCH40 PVC
16..INNER
CASING OR: TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
fL
$
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
fL
ft,
in.
ft.
h
in.
1& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
23 ft
Bentonite
Poured
ft.
ft
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
R
R
20. DRILLING.
LOG (attack
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardnea, soirrark type, grain size, etc.)
0 ft'
22 ft
Sands
22 ft.
30 ft.
Clay
30 ft
95 ft
Sand/some clay lenses
95 ft.
120 2
Limestone/sandstone mix
ft
ft.
fr.
JUN 0 5 2.017
.REMARKS ,..
entoomme21,
n e''roFi$&34ing UiVt
IDM/80`S
22. Certification:
�a
igltetare of Certified Well Con IPRCior
05/12/17
Date
13y signing this form, 1 hereby certIfr that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Ca ssmrction Standards and that a
copy of this record has been provided ro the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail 19G
Service $t16AS
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
JUN 12 2017
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center. Ra r h, 27699-I 36
water Qualityy Regional
24c. For Water Sunnly & Iniection lei7Biatioftlatemtitnnsending the fonn to
the address(es) above, also subnwlifiTNrt( flei$e(jiertilf 4 hero 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #: N/A
all applicable well construction permits (i.e. U1C. County, Stale, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Ilndustrial/Commercial
cplrrigation
Non -Water Supply Well:
Monitoring
f Municipal/Public
()Residential Water Supply (single)
()Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
ryGeothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/12/17
5a. Well Location:
The Dirt Nerds
['Groundwater Remediation
0Salinily Barrier
fStormwater Drainage
()Subsidence Control
DTracer
Other (explain under #21 Remarks)
well ID# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
619 S. Kerr Ave, Wilmington, NC 28405
Physical Address, City, and Zip
New Hanover R05511002016000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well &eld, one let/long is sufficient)
34 13 32.72 N 77 53 08.42
w
6. Is(are) the well(s)01Permanent or Difemporary
7. Is this a repair to an existing well: ®Yes or xONo
If this is a repair, fill out known well construction information and explain the narme of the
repair under It21 remarks section gran the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 5
9. Total well depth below land surface: 140
For multiple wells list all depths if different (exmnple- 3(a)200' and 2@100')
10. Static water level below top of casing: 17
(ft.)
(ft.)
If water level Is above casing, use "+"
11. Borehole diameter: 0-60/8" 60/6 (in )
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
0
13b. Disinfection type: HTH Amount: 3 fo@10g
For Internal Use Only:
444103
,14. WATERZONES
FROM
TO
DESCRIPTION
ft
ft.
ft
15. OUTER CASING (for maid -cased wells) OR LINER_ftf ap lieable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0
60 ft
6 '"'
SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loopy
FROM
TO
DIAMETER
THICKNESS
MATERIAL!
0 R.
120 ft
4" t"'
SCH40
PVC
ft.
ft.
in.
17. SCREEN ...
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
120 rt
140 ft
2 in'
.010
SCH40
PVC
R.
ft
7S GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
22 H•
Bentonite
Poured
ft
ft
ft
R.
19. SAND/GRAVEL
PACK
Of applicable) ='
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
R.
R
20.:DRILLING
.LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hankies, soiarock type, grain MEE, etc)
0 it
60 ft
Sand
60 fc
120 ft•
Limestone sand
120 ft
140 is
Limestone •
ft.ft
W
pp_
G.s• idbi P. „).
ft
tt
R
JUN 0 S 2017
ft
ft•
Infonnnatjc'nProx;ensWilUrea
21. REMARKS rb4$g:Ui$E..
05/12/17
Date
By signing this form, 1 hereby cenjy that the well(s) was (were) constructed in accordance
with ISA NCAC 02C.0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to thefollowing: fp�CC��ppppll��//yyppryry Iprya
`' IAfdlghdfldihGt,t.:.,' 11
Division of Water Resour t-.: 1mplt,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to s fpglpgg.ihesfoLN,iprthe address in 24a
above, also submit one copy of this form t �0 ty449 bompletion of well
construction to the following:
Division of Water Resources, Und It lhQBO{ittiMe ip(jgjl Program,
1636 Mail Service Centeirim, telkJ 36
Wilmington Ragtonal (ice
24c. For Water Simply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health deparunent of the county
where c nstructed.
Form OW -I North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22.2016

cuiina
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC
City or Town State
( 910 1-231-6669
Area code- Phone number
2. WELL INFORMATION:
28429
Zip Code
SITE WELL ID #(inapplicable) (y�y
WELL CONSTRUCTION PERMIT# A) P (3 ag'g�y` -t j
OTHER ASSOCIATED PERMITtt(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED S—`h -f11
TIME COMPLETED c°
4. WELL LOCATION:
CITY1: ____(
(Sae NatNumbers. Comrn n
TOPOGRAPHIC /
0 Slope 0 Valley Fia( o Ridge a Other
(check appropnate box)
LATITUDE
LONGITUDE
Latitude/Iongitude source: it GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
6. WELL OWNER
OWNER'S NAME --
STREET ADDRESS
( t r s/\' tit_
(4\C >_ `i-1-1—'/(7 314‘
{COUNTY fell, i4cfnver
G' 'P'rc od
ubdivision, Lot No., a . Ce)
ETTING:
Y•
City or own State
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
e. WATER LEVEL Below Top of Casing: ' 5r L FT.
(Use 'se If Above {dTop of Casing)
d. TOP OF CASING IS 4- 1 FT. Above Land Surface
*Top of casing terminated aVor below land surface may require
a variance in accordancewith 15A NCAC 2C .0118((. 11 ((��
e. YIELD (gpm): [: METHOD OFTEST.Tri,
,,t(ir44--
MA`( 302
04i^n)10
r. P•_ceg
tv0'ii'17
443381
L DISINFECTION: Type t-{ T 14
Amount Q. , Ul r
g. ZONES (depth):F
FrommTO \, t`) From To
From To i. tCi From To
From To From To
7. CASING: of Thickness/
From .� .4 DTo FL Diameter WAig t#0 M;.ti) t_
To Ft. 1-� Y.11 rot
To Ft.
From
From
8. GROUT: Depth et Mayiapl i Method
From To cy(t Ft £r t�C1�1 eari
From To aFt.
To Ft. iy
krom
9. SCREEN:_Depth Diameter SIgt Si Mpeert�
From ) To l36d Ft C) in. tOOin. t' V
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth _SiizeMaterial I'`
From ice To 1Rf3 Ft.2 W'etl (Wwe1
Rom To Ft.
From To Ft.
11. DRILLING LOG
Qom5 To
so.- t75' c ray -3- at yo-6V iC\
r75 - t (f1 L'k Mt S-trfe
g
so- tit
Sac\ck 54i,yiK irf)
712. REMARKS:
Sc\(ig.4.-7 i, � ,5anek5 C.00L5h.
f, p COjt - (thPh PA+ Cat$;�.c
15A NCAC 2I DO CCERTIFY THAT THIS VVELL WAS EEN CO4STRUCTTJON STANDARDS,ANDT AT IN OF THCS WITH
RE
ORD
l
S IGN TORE OF CERTI b WELL CONTRACTOR DATE
Michael C VFD(NCDENR/DWR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
JUN 0 5 2017
Submit the original to the Division of Water Quality within 30 days. Atbutinfpngsgpto Mglional
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] Wilmin Regional ion
Office
Form GW-la
Rev. 3/07

Ro3 Q?[ck Dr,
,
30'
RECEIVED/NCDENR/DWR
JUN052017
Water Quality Regional
Operations Section
Wilmington Regional Office
00 Sane
r Be iicve
\ ©een En) W5346-05n
Sfe '1SO`
offal (� eP-lk 1G r

CATLIN
Engineers and Scientists
Post Office Box 10279
Wilmington, North Carolina 28404-0279
Telephone: [phone]
Fax: [phone]
www.catlinusa.com
May 22, 2017
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction and/or Abandonment Record(s)
Rollform, Inc. Well Abandoment at North Carolina State Ports Authority
Wilmington, NC, North Carolina
CATLIN Project No.: 216137.04
To Whom It May Concern:
CATLIN Engineers and Scientists (CATLIN) recently constructed and/or abandoned well(s) at the
above referenced site. Attached to this letter are completed North Carolina Well Construction Records
and/or North Carolina Well Abandonment Records with associated Attachment(s) for the above
referenced site located at North Carolina State Ports in Wilmington, NC, North Carolina.
If you have any questions or require any additional information, please feel free to contact us at (910)
452-5861.
Sincerely,
Michael E. Mason, P.E.
Project Manager
Enclosures
SIGINT\PROJECTS\216136.06 NCSPA WELL ASANOONMENT.GPJ.«DrawingFileSPec»
RECEIVED/NCDENR/DWR
MAY 3 0 2017
Wilmington Water Quality Regional
Operations
Regional Office

NONRESIDENTIAL ON ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality A D tw n ' ' &
WELL CONTRACTOR CERTIFICATION # 2412-A " 3 ) � o l
1. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation( Other 0 (list use)
DATE DRILLED 07/19/12
4. WELL LOCATION:
1213 Culbreth Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 34 "DMS OR
LONGITUDE 77 ' "DMS OR
Latitude/longitude source: 3PS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
DD
DD
33 b5,
Facility Name Facility ID# (if applicable)
Street Address
City or Town
Landfall Executive Suites
Contact Name
1213 Culbreth Dr
Mailing Address
State Zip Code
Wilmingtnn NC 2R405
City or Town State Zip Code
( 910 ) 509-7250
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 160'
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing:
NO
FT.
(Use "+" if Above Top of Casing)
F6
Coy`
d. TOP OF CASING IS 0' FT. Above Land Surface*
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 70 METHOD OF TEST Airlift
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth
Top 0' Bottom 75' Ft. 6"
Top 0' Bottom 140' Ft. 4"
Top Bottom Ft.
Amount 31:1A10%
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight Material
sch40 PVC
sch40 PVC
8. GROUT: Depth Material
Top 0' Bottom 23' Ft. Grout
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 140' Bottom 160' Ft. 2" in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 60'
60' / 95'
95' / 135'
135' / 160'
/
Method
Tremmie
Slot Size Material
.020 in. PVC
in.
in.
Size Material
Formation Description
Sandv clay / sand
Limestone (cave 0 63')
PD mud / mud rock mix
Sandstone
l PAY 15 2017
/ VINE
12. REMARKS:
9ttCEIVED/d�iltEl�#P/�9�
MAY 2124,o
Water *OW Regiiaial
Operations Section
1 00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
asr on HAS BEEN PROVIDED TO THE WELL OWNER,
SIGNATURE OF CERTIFIED WELL COl CTOR 07DATE1 %
Donald H Cummings
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit Within 30 clays of completion to: Division of Water Quality - Information Processing
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2412-A
1. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation) ' Other ❑ (list use)
DATE DRILLED 07/19/12
4. WELL LOCATION:
7101 Lona Boat Circle
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington • couNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 34 "DMS OR
LONGITUDE 77 ' "DMS OR
Latitude/longitude source: VGPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
DD
DD
J3 O5J
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Karen Hollingsworth
Contact Name
7101 Lona Boat Circle
Mailing Address
_ Wilminatnn IC 9R405
City or Town State Zip Code
( 910 ) 799-0196
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 150'
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: 23'
NO t f
FT.
(Use "+" if Above Top of Casing)
40'ii"'
d. TOP OF CASING IS 1 5' FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) 60 METHOD OF TEST Airlift
f. DISINFECTION: Type HTH Amount 3n@10%
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top +1.5' Bottom 135' Ft. 4"
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0' Bottom 20'
Material
Ft. Grout
Thickness/
Weight Material
sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top 135' Bottom 150' Ft. 4" in. .020 in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in,
10. SAND/GRAVEL PACK:
Depth Size
Top 125' Bottom 145' Ft. #2
Top Bottom Ft.
Top Bottom Ft.
Method
Tremmie
Material
Sand
Material
PVC
11. DRILLING LOG
Top Bottom
0' / 52'
52' / 90'
90' / 135'
135' / 150'
loyjnovi
12. REMARK
Formation Description
Clay / sand
Limestone
Clay
Sandstone (Cave 0 150')
1
V
RECc4V1 j ifiNR/DWR
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRI#44X Th4 20g E WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RD HAS BEEN PROVIpEDT THE WELL OWNER.
fi. �1
SIGNATURE OF CERTIFIED WELL
Donald H Cummings
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Water Quality
Akkais ions
l Office
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-Ib
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] Rev. 2/09

03/26/2012 04:01
9103133102 AQUA WELL
PAGE 07
i:ysya,Ia .ADl\rt? .;^. J' .ILAU.tq ic:..r.:..vuem
4 4 i i of
w¢��11 ' - 'Z.)ue.S. CEnF;r:t,:D.AT1®N a L-/99
WELL P:IY,.;.;::iY:ak tlW®IY':.;li (i)NAIN6 (prise) �J/+`"r
wE➢.R.S;:1:':'.:.'.'9CaCoss :r. i.t,:u7E Arii..lt.q k.,'P16 p1._/I•.4el':� Px,Dfd:;tnOawe) 29r-d5'yt?
SLA.TIS9!':::.:.do1.1ETIMIfT:. ";;i'AFEW "1/,e .,rASSOCIW it:.: rQPB@1ttttw
(itaiarli,eahie) _ ;ipe!IcaWel
1. WEIi.';l:i i(CiteckAr h. Box): Residential i" ./uniclpMUPublic i,l Industrial 0 Agr^rtGhrral
Nian"r: r. i c E-1 Retow. 1.1 !Jag Pump Water Intiz.Nion C1 Other ID 110ther. List (Ise__Zeper tt
2. WELi. L.! i ;ATOM
Noma t, i „r.C oamya:_ew
(Sire: ii';,'i i P.umuera;cor,::. a; :3uhdivision,tatNo.,ZtpC ;a)
3. OWI,1?;R._ Ofto, 3 4-01140v43'
L!o2 Teti! o 4re+e.. G.r
(3Uaar .r ..:.,...V9.1
zip Code
Aeeo :r.: o- ?t :nc nunher -
4. DA_13',..?;2::2ED ,2- • /1
5. TOT/ :., :i:i ,?n1 .2 9'_._.
6. DOE;:•':;:?, .L FIEPLA':L' :0.11i:'1NG WELL? YE::1 „;I NO Or
7. STA::II:: tl ATERLE!? F. .."::•1r,vTop ofCasing: ,___/2- F'I'.
tun ` - IfAbove Top or .r4,ing)
8. TOP ,SL*' G YS!i� FT. AboveLand ; r:Fucer
uar •Telr n:,:ti reienotoar'• , ._ 7 ua'laedstuircerequirenn-
terde:: •G:: :meant tiri: r ..:. `F ]:iC 2C.0118.
9. YIEL.:..;;r n):. ieU !e9ETHODOFTEST trio
_Wi55ldep::.j
L In
11. DISIFI iiO.a: Yyp.
12.
Geph
Front. ^f_(._To au
From Co
Wall Tldcl.r::is
Diwne, ler or Walston. Material
.i_ S�tie,eye.
13. GROI.: r, Depi i Material Method
Frnt Q To Ao fio/t P/o, /CHLta
14. SCREU..v: Depth
From_a# . o iS_
--....
15. SA'l4?:,.'::':,,VELPAC
Depth
Prom to
-_
16. RDP/tit'''.
1. DO HER]:::•.' [ SETIF!' TR.,'
CONSTLI::'i. ii . STAt10;i::,3;
San* tl. (1,,11Aelltap floe D.
Radek to: '+.',. 11(51/, Ph.:n
Xvrneter Slot Size Material
0/0 in, fue
in.
f1.
Size Mettri:
Topographic/LF: r setting
I::iRidge OSlope i;:!'Irs Iley GtFlat
- (deckappropre w:ei
Latituddlongitude t tr31location
(aegtees/minwr_ (41: m(1s)
Latio:,r,•e.Yengitude aource:GCl? : C:ITopograpbic map
ICk. �dc has)
:;ml • ); NILLINO LOG
Fran, To Tar:aation Description
O - a u SA -et
? o 3 B • C.j mrS C.0-a
LOCATION Sh:;1
Show direction and distance tit rifles Brrom at least
two .l ale Roads or County T i ar s. Include the road
nuntaer:; and cowman road r,::,:s.
//04
Tu.R'e1+
MAY222017
C,4 i&/A.e ,44 /( Sa 1",
Water Quality Regional
Operations Section
Wilmington Regional Office
WELL WAS CONSTY•g2TED EN ACCORE AI: cE WITH ISA NCAC: ':,:!. WELL MAY 1 20/7
/1 I, THAT A OppV t11+ ; " rIS RECORD HAS 1:RIS4 PROVIDED TOPE ;'ELL OWNER
3 At -ice VME
;a.'.3NSTRUCTINGTIES 'ilr6LL T•
i v.a of Water Quality„ A I.: Infermatloa 1i5.:::a::lgenie nt,1617 Mas::w /b e: Carder -
±;. C•19) 733-7015, !Mitt.. ?G days.
W
VED
MAR 2 'i 2092
information Processing unit
DWQ/BOG
RECEIVED 03-26-'12 14:49 FROM- 9103133102
TO- NC DENR P&S P007/011

Cop
40.0691
1. WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (Individual) Name
TERRACON CONSULTANTS. INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH
City or Town
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
NC 27605
Stale Zip Code
OTHER ASSOCIATED PERMIT#Qlapplicable) N/A
SITE WELL ID #fdapplicable) EI-2011-PZ- -2. et
3. WELL USE (Check One Box) Monitoring fi 'Municipal/Public ❑
Indusbial/Commerclal O Agricultural Recovery Injection CI
InigaiJonD Other 0 (list use)
DATE DRILLED 11/02012
4. WELL LOCATION: .
EAGLE ISLAND
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
ciTY: WILMINGTON COUNTY NEW HANQ119-
TOPOGRAPHIC f LAND SETTING: (check appropriate box)
❑Slope DValley ['Flat DRrdge {Other 04wnt%+°t•MJ
LATITUDE 36 " DMS OR S� • I16f9 DD
LONGITUDE75 ° " DMS OR 41. 6005 DD
LatlludeAongilude source: MPS propographic map
(location of well must be shown on a USGS topo map andattached to
this form not using GPS)
6. FACILITY (Name of the business where the well is located.)
Cnnfined Ilisnosal Facility N/A .3
FacilityName
N/A
303
/
Facility ID# (if applicable)
Street Address
FAfI F ISI ANf) NC
City or Town
frn /mac Crcj
on(acl Name r rI � r 4
kle J Q
all g Ad ress l Ij-]) r/C C {
Wit MINGTON NC 2.8'�(
Clty or Town State Zlp Code
410) 25 1 4biE
Area code Phone number
6. WELL DETAILS:
e. TOTAL DEPTH: 2,5
b. DOES WELL REPLACE EXISTING WELL?YES ❑ NO 1l
c. WATER LEVEL Below Top of Casing: (1, Ir ` FT.
(Use °t° I/Above Top of Casing)
State Zip Code
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3423 2
d. TOP OF CASING rS r� .1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
1. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top I'i• 2. Bohol Top Bottom
Top Bottom
Top Bottom
Top
Top
Bottom,
Bottom
Thickness/
7. CASING: Depth Diamet r Weight Material
Top 1 L I Bottom S T - Ft.s- ? V C
Top Bottom Ft.
Top Bottom Ft.
8. GR T: Depth i Material
Top - Bottom 7-r7 Ft. P CC
Top Bottom Ft.
Top Bottom Ft.
Method
rise'' n'i
9. SCREEN: Depth Diameter Slot Size
Top 2-5-Bottom 3 S Ft. 2. in. 0 • J In.
Top Bottom Ft. in. in.
Top
Bottom Ft. In. in.
10. SAND/GRAVEL PACK:
Depth
Top '2 5 Bottom 3 ' Ft
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
: 98.s
29.51-3 -
— t711E
12. REMARKS:
Size
Ft.
Ft.
Material
pvL
L) - sqial rs.tl
Formation Dascriptlon
cL1413
Strf 0
Sff—r
MAY 2
WED
wsp 19201
2 2011
IntormaiwOWQIBOGIny UnA
Waterl•lDality RHcional
I D0 HEREBY CERTIFY THAT THIS
fWELL 'y' • gt 1W2TeDtMXtCOROANCE WITH
I SA NCAC 20, WELL
CONSTRUCT!
4g tr?.& WdEYt. efty11 f7 THIS
3/12/12
SIGNATURE OF(CERTIFIED WELL CONTRACTOR DATE
WII J IAM T. DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

r
4037681
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3423
1. WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (Individual) Name
TERRACON CONSULTANTS. INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH NC 27605
City or Town State Zip Code
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(Happlicable) N/A
SITE WELL ID #(if applicable) EI-2011-PZ- 2./-
3. WELL USE (Check One Box) Monitoring ITIMunicipal/Publlc ❑
Industrial/Commercial❑ Agricultural Recovery injection
IrrigaUono Other O (list use)
DATE DRILLED 11/jV/2012
4. WELL LOCATION:
EAGLE ISLAND
(Street Name, Numbers, Community, Subdivision, Lot No.. Parcel. Zip Code)
cfrm: WILMINGTON couNTYNEW HANCtNJIrU-
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley offal ❑Ridge RI Other 6811pAlh "
LATITUDE 36 ° ' " DMS OR 34 °I 4'Sb 8 DD
LONGITUDE TS " DMS OR ? 1.C1 j Qd b DO
Latltudellongilude source: IMPS ['topographic map
(location of well must be shown on a USGS topo map andaffached M
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Confined Iliannsal Facility N/A 3303
/
Facility Name Facility ID# (If applicable)
N/A
Street Address
FAGI F IRI_ANIl NC
City or Town State Zip Code
on ct Napak`tre/
)rr' 11hy to ilvenVP
ail gAds V
WII MINGTON NC 2a'
City or Town State Zip Code
I Lv) 25( 4ICAC
Arda code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO li
c. WATER LEVEL Below Top of Casing: (�.f FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surfaces'
*Top of casing terminated at/or below land surface may require
a valance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top !7-1 Bottom ti Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diamet Weigh! aterial
Top T3'LBottom Q'S Ft. pY�
Top Bottom
Top Bottom
B. GROUT: Depth Material
Top 10 Bottom33 FI. pCG
Top Bottom Ft.
Top Bottom Ft.
Method
9. SCREEarN�: Depth Diameter Slot Size
Top 3 1 Bottom 4S FL 2 In. 01 I - in.
Top Bottom Ft. in. In.
Top Bottom Ft. In. in.
Material
10. SAND/GRAVEL PACK:
Depth 4. r Size Material
Top 3 3 Bottom ✓- Ft. II .2
Top Bottom F1. +�
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
O / Ib
/ ¢ j
_LC
/
um7
12. REMARYME
Formation Description
sf /re 5*.n
5 Irer�
$A-NN
ED
9 2012
Informatlo Unit
MAY 222017
100 HEREBY CERTIFY THAT THIS WELL WAS dillatetetali WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDIJ �tfif �LC
RECORD HAS BEEN PROVIDE HE WEIon
��'��'��'��'��1111555555����`` Regional i
SIGN I�E OF CtrF FYED WELL CONTRA T(. R DATE
WILLIAM T. DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mall Service Center, Raleigh, NC 27699.161, Phone : [phone]
Form GW-lb
Rev. 2/09

4n:;7661
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3423
1. WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (Individual) Name
TERRACON CONSULTANTS. INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH NC 27605
City or Town State Zip Code
(919 -) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(g applicable) N/A
_Q
SITE WELL ID Air applicable) EI-2011-PZ- �_ p
3. WELL USE (Check One Box) Monitoring dMunlcipal/Public ❑
Industdat/Commercial ❑ Agricultural 0 Recovery D Infection 0
Irtigationo Other ❑ (list use)
DATE DRILLED ty111/2012
4. WELL LOCATION:
EAGLE ISLAND
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) .
CITY: WILMINGTON couNTYNEW HANC3NtL
TOPOGRAPHIC / LAND SETTING: (check appro Bete box)
oSlope oValley OFlat ❑Ridge IVOther tWfrfrtlaii(1•"'-
LATITUDE 36 0 "DMS OR 34.2003) DD
LONGITUDE 75 DMS OR ' ?4'?" S DD
Latilude)ongitude source: Q(GPS Dfopographfc map
(location of we#must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well Is located.
Ilisnnsal Facility N/A 3 303
Facility Name - FacilitylD# (if applicable)
N/A
Street Address
FAGI F ISI AND NC
City por Town State Zip Code
G
on•I / 4t
tolN rt!ih��Oo Atef�e
Confined
NC: 2.8%,
Clly or Town Stale Zip Code
ailingG(c a
Ad ress
WII MINC;TON
464to
Are code Phonnumber
6. WELL DETAILS: ] J
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?? YES D NO El
o. WATER LEVEL Below Top of Casing: Ilk' FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING Is 2-f' FT. Above Land Surface*
"Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Typo N/A Amount N/A
g. WATER ZONES (depth):
Top iMI Bottom 7iri Top Bottom
Top Bottom, Top Bottom
Top Bottom . Top Bottom
Thickness/
7. CASING: Depth Diam or Weight Material
Top ti•* Bottom '35 Ft. r .P VC
Top Bottom_ FI.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 7'5 Ft. PC- t Ter0p.11 G
Top Bottom FI f
Top_ Bottom FL
9. SCREEN: Depth Diameter Slot Size
Top 7S Bottom 3% Ft. 2- In. 0•1 in.
Top Bottom Ft. in. In.
Top Bottom Ft. In. in.
Material
PAC
10. SAND/GRAVEL PACK:
�2 3
Depth Size Material
Top 22 Bottom S Ft. # 2 5/10/)
Top . Bottom Ft.
Top. Bottom Ft.
11. DRILLING LOG
Top Bottom
O / 20.S-
2G.S 3S
I I�.©Y"° 417
12. REMARK
Formation Description
SSr `T
Pcoco4cc19 Un
MAY 2t11?1rolu°nG
Water Quality Regional
I DO HEREBY CERTIFY THAT THIS WELL WpIl$$,�c�ONSTR010121 1S,Dpp gNmCE WITH
15A NCAC 2C, WELL CONSTRUCTION STAN6yJlnyjRLI @,COP XEF Ce
RECORD HAS BEEN PROVIDED TO THE WELL OWNER: 61� UTH
N'A'FT1Rt` 0'C 3/12/12E
SIG 91{yfFlt'D WELL CONTRACTOR DATE
WII I IAMT. DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-lb
Rev. 2/09

65S
1. WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (individual) Name
TERRACON CONSULTANTS. INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH
City or Town
[phone]
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
NC
Stale
OTHER ASSOCIATED PERMIT#(if applicable) N/A
SITE WELL ID Rif applicable) EI-2011-PZ-
27605
Zip Code
3. WELL USE (Check Ono Box) Monitoring d'MunlclpallPublic ❑
Industrial/Commercial 0 Agricultural 1D Recovery O Injection 0
Irrlgagon❑ Other 0 (list use)
DATE DRILLED 1,1//1/2012
4. WELL LOCATION:
EAGLE ISLAND
(Street Name, Numbers, Communsy, Subdivision, Lot No., Parcel, Zip Code)
CITY: WILMINGTON COUNTY NEW HANCII40A
TOPOGRAPHIC / LAND SETTING: (check appropdate box)
❑Slope oValley ❑Flat ❑Ridge Of/Other &Tl?raNi'tw.+f
LATITUDE 36 "VMS OR3'• Zt•g3DD
LONGITUDE75 " "DMSOR 3% Of2BD
Latitude/longitude source: Ixi3PS Dropographic map
(location of wellrnustie shown on a USGS topo map andaftached to
this form finot using GPS)
5. FACILITY (Name of the business where the well is located)
Confined Disnnsal Facility
Facility Name
N/A
Street Address
FAGI F ISI AMP-)
City or Town/ )
frn
d Nonni
rio n
MailfCC/g ress c J'_ Ad • L
WII MINGTON NC 48'`
Cityor Town Slate Zip Code
f �(1) tis$ 46 P
Area code Phone umber
N/A 2,) O3I
Facility ID# (If applicable)
NC
6. WELL DETAILS:
a. TOTAL DEPTH:
45'
Slate Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1 /
c. WATER LEVEL Below Top of Casing: 24 • 3 FT.
(Use `4" if Above Top of Casing)
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3423
d. TOP OF CASING IS 3 • 7 FT. Above Land Surface*
`Top of casing terminated a#or below land surface may require
a variance in accordance with 16A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth),:I
Top 2Q • 2 Bottom 4'5 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Blame r Weight Material
Top44•3 Bottom 64y/ Ft. 4C
Top Bottom Ft.
Top Bottom Ft
8. GROUT: Depth qq
Top 0 Bottom 33 FI.
Top Bottom Ft.
Top Bottom Ft.
Material
?c
Method
Trrth;(
9. SCREEN: Depth Diameter Diameter Slot Size Material
Top 3S Bottom 4S Ft. 2- fn. 0_' in PVC
Top Bottom FI. in. in.
Top Bottom Ft. In. In.
10. SAND/GRAVEL PACK:
-B2 Depth Size Material
Top 7 7 Bolton Ft ' Z 5/9W D
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom
/ 2tS
27 51 lc
ivtRfrt
52U
12. REMARKS:
Formation Description
5. Awl)
S' t•T
MAY 2 etoc,
\n(etm� --1 y5
ter uuaiity Regional
1 DO HEREBY CERTIFY THAT THIS Mrs
15A NCAC 2C, WELL CONSTRUCTION ST
RECORD HAS BEEN PRO 4 ED TO THE WELL OWNER.
SCCpRDANCE WITH
doyfgfeTHIs.
SIGNAT REF' Ef I WELL CONTRA TC O DATE 3/,
WII I IAM T DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mall Service Center, Raleigh, NC 27699-181, Phone : [phone]
Form GW-lb
Rev. 2/09

Cop
NONRESIDENTIAL ONRESIDE'NTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ti 3423
1. WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (Individual) Name
TERRACON CONSULTANTS INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH
City or Town
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMITEntapplicable) N/A
NC 27605
State Zip Code
SITE INELL ID#(irappiicabre) EI-2011-PZ- 5�
3. WELL USE (Check One Box) Monitoring is/Manlclpal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection 0
Irrigationo Other 0 (Ilst use)
DATE DRILLED 12/1912012
4. WELL LOCATION:
EAGLE ISLAND
(Street Name,Numbers, Community, Subdivialon, Lot No., Parcel, Zip Code)
CITY: WILMINGTON couNTYNEW HANC211M
TOPOGRAPHIC / LAND SETTING: (check epproppddate box)
❑Slope DValley ❑Flat DRIdge r)/4lher Y a+b Ke
tt WY v14
LATITUDE 75 "DMS OR7
LONGITUDE 75 " OMS OR
Latitude/ongitude source: MPS Oropographic map
(location of well must be shown on a USGS topo map andaftached fo
this form if not using GPS)
6. FACILITY (Name of the business where the well Is located.)
Confined Disnnsal Facility N/A 330 3/
Facility blame Facility ID# (If applicable)
N/A
Street Address
FARI F ISI AND NC
City or Town State Zip Code
C�onlacl NaOle f r �4 Ave vt ue
Mat Adele; t/
WI! MINGTON
City or Town
NetP
State Zip Code
( 910 ) 25l 46tk0
Area code Phone number
6. WELL DETAILS: I
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 N0 Gif
c.'WATER LEVEL Below Top of Casing: tet• FT.
(Use °+" if Above Top of Casing)
d. TOP OF CASING IS • 6 FT. Above Land Surface*
'Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
a. YIELD (gpm): N/A METHOD OF TEST N/A
F. DISINFECTION: Type N/A Amount N/A g. WATER ZONES (depth):
Top 'b •C Bottom 3b Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness)
7. CASING: Depth C blame r Weight Material
Top 4145 Bottom 3J Ft PVC --
Top Bottom Ft.
Top Bottom FL
8. GROUT: Depth Material
Top 0 Bottom Zvi Ft PCC
Top Bottom FI.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top 24- Bottom l5 Ft. 2. In. (t) .1 In.
Top Bottom Ft. in. In.
Top Bottom Ft. In In.
Method
T/'r°IMIf
Material
?vc.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 2) Bottom, ;5- Ft. -ji- 0 rSn,/
Top Bottom Ft
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
(Q / 2-4b
Wilt)
Formation Description
Sf Np
Sfcr
09
Water Qu li0011
�c}I
on R pone) Office
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
16A NCAC 20, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS 1F•Ey PROND HE WELL OWNER.
SIGMA OF
3/12/12
ELL CONTRACTOR DATE
WILLIAM T DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1817 Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-I b
Rev. 2109

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3423
1. WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (Individual) Name
TERRACON CONSULTANTS. INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH NC 27605
Clly or Town State Zip Code
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
SITE WELL ID #(f applicable) EI-2011-PZ- �(y
3, WELL USE (Check One Box) Monitoring BiMunlclpallPublic❑
Industrial/Commercial ❑ Agricultural Recovery0 Injection❑
Irrigation': Other0 (It to
DATE DRILLED: J2_f 2-
4. WELL LOCATION:
EAGLE ISLAND
(Street Name, Numbers, Community, Subdivision, Lot No„ Parcel, Op Cade)
CITY: WILMINGTON cowryNEW HANGS
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
Slope Malley ❑Flat ❑Ridge tgOther e IN 1j1INJOr°r°t t1--
LATITUDE 36 "DMS OR •IVOW DD
LONGITUDE 76 "DMS OR ?f• / pDD
Ladludeiongitude source: IZGPS [iconographic map
(location o1 well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Confined fiisnosal Facility N/A 3303
Facility Name Facility ID# (it applicable)
N/A
Skeet Address
FAC;I F IRI ANf)
City or Town
hPtcWC,
onct Npd./Jill/Do
rAe r ! g-
etting 1-0 dvr^ ue
Ad ress_ l V /�' , L
No
Slate Zip Code
City or Town
zS l 4104D
Are9 code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
ZS
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO cj
c. WATER LEVEL Below Top of Casing: (5 FT.
(Use °+° if Above Top of Casing)
13
—/3--.Zr
/
d. TOP OF CASING IS 3 's FT. Above Land Surface'
'Top of casing terminated aUor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top 15.t Bollom tj Top Bottom
Top I Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth .. Dlame�t Weight Malerlal.
Top.r4< Bottom 2.J Ft. 5. VC
Top Bottom Ft.
Top_ Bottom Ft.
8. GROUT: Depth Material Method
Top r j Bottom 12 7 Ft. rC-G freteett i.-
Top Bottom Ft.
Top Bottom FI.
9. SCREEN: Depth) Diameter Slot Size aterial
Top 15 Bottom .2. 7C FL % in A . ) In. ✓C
Top_ Bottom Ft. In. In.
Top Bottom Ft. In. in.
10. SAND/GRAVEL PACK:
Depth �^ Size ,+ M rh ,4
Top (17 Bottom_ 21 Ft. �tr
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom Formaton Description
8 A- S(tilD
sf� EC1
ROY 15zoo
/
I
12. REMARKS:
APR tot
ece55Ta9
er`tot1lau0�QlgpG
RECEINED/WGDtNK/VWR
2 2 ?0i7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
TSA NCAC 2C, WELL CONSTRUCTION STANDARDS, qqggpp VAT,* CO YOF THIS
OTHE WELL OW RECORD HAS BE N PRO NERYater UDality Regional
J WII OperatiOnL g.�
SIGNAT E OF ER'rlylED WELL CONTRA Wit e
WIl I JAM T DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submitwithin 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27698.161, Phone : [phone]
Form GW-lb
Rev. 2/09

.NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2869
1. WELL CONTRACTOR:
Bobbie Fowler
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach
NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A - On- Site
OTHER ASSOCIATED PERMIT#(if applicable) N/A- Ambient Air
SITE WELL ID #(if applicable) PAS-5
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection
Irrigation❑ Other 0 (list use)
DATE DRILLED 1-5-2012
4. WELL LOCATION:
602 Sunnyvale Dr. 28412
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTYNHC
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope 0Valley elat ❑Ridge ❑Other
K1WISTCD 34 InnnnAnnnnnnnnl CL ROR 340$7847AAAA cc
IO1Nff ISTCD 77 IAAAA&AAAAAnnnl CL ROR 7.71i934ennnnn CC
Latitude/longitude source: MPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
S&R Packina and Crating
Facility Name Facility ID# (if applicable)
602 Sunnyvale Drive
Street Address
Wilminnton NC 28419
City or Town State Zip Code
Steve Tyler
Contact Name
804 Porters Neck Rnad
Mailing Address
Wilminntnn
City or Town
( 910$ 508-8833
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 42
NC 28411
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO LW
c. WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
443716
"M
d. TOP OF CASING IS 2' FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top 5 Bottom 42 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 40 Ft. 1" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 36- Bottom 39
Top 0 Bottom 36
Top Bottom
Material
Ft. Bentonite Chi
Ft. Grout
Ft.
Method
pour
9. SCREEN: Depth Diameter Slot Size Material
Top 40 Bottom 42 Ft. 1 in. 0.01 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 31 Bottom 34 Ft. #2 Torpedo
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/ See attached
tlV G
12. REMARKS:
RECEIVED/NCDENWN1 ZO12
ininriTralion Pc?:
MAY 2 2 21112
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TQTh NE
f aliVPRegional
s S Ction
01 SIGN4TURE OF CERTIFILtl7t90HP,EW Ice 1 DATE
Bobbie Fowler
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh,; NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 1/08

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2869
1. WELL CONTRACTOR:
Bobbie Fowler
Well Contractor (Individual) Name
Mid -Atlantic Drilling. Inc
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach
NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A - On- Site
OTHER ASSOCIATED PERMIT#(if applicable) N/A- Ambient Air
SITE WELL ID #Of applicable) PAS-5
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public❑
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection gif
IrrigationD Other 0 (list use)
DATE DRILLED 1-5-2012
4. WELL LOCATION:
602 Sunnyvale Dr. 28412
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
aTv: Wilmington COUNTY NHC
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley grFlat 0 Ridge ❑ Other
I4 FSTCD 34 IAAAA&AAAAAAAAI CL ROR 344 7647AAAA CC
IQJ ivIF ISTCD 77 i AAAASAAAAAAAAI CL R OR 77193$2AAAAA CC
Latitude/longitude source: MPS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this form ifnot using GPS)
5. FACILITY (Name of the business where the well is located.)
S&R Packing and Crating
Facility Name
602 Sunnyvale Drive
314(Z,
Facility ID# (if applicable)
Street Address
Wilminatnn NC 28417
City or Town State Zip Code
Steve Tyler
Contact Name
804 Porters Neck Road
Mailing Address
Wilminatnn NC 28411,
City or Town State Zip Code
( 91041 508-8833
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 42
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
c. WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
443716
d. TOP OF CASING IS 2' FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top 5 Bottom 42 Top Bottom
Top Bottom - Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 40 Ft. 1" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 36- Bottom 39 Ft. Bentonite Chi pour
Top 0 Bottom 36 Ft. Grout
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 40 Bottom 42 Ft. 1 in. 0.01 in. PVC
Top - Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 31 Bottom 34 Ft. #2 Torpedo
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/ See attached
/ MAY 16ZO17
/
RECEOVCD/NCDEt4RYD1 R
mAR 1 2(112
12. REMARKS:
MAY 2 2. 2017 Unit
Information,cat;edn(t
I DO HEREBY CERTIFY THAT THAW/
15A NCAC 2C, WELL CONSTRUCTId paVN4y CON
ttARDS,,
RECORD HAS BEEN PROVIDEW 066R gopna
n n
Bobbie Fowler
D IN ACCORDANCE WITH
,COPY OF THIS
1-11-201
CONTRA TOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -'Information Processing,
1617 Mail Service Center, Raleigh, NC 27699.161, Phone : [phone]
Form GW-lb
Rev. 1/08

NON RESIDENTIAL WELL CONSTRUCTION RECORD 443715
North Carolina Department of Environment and Natural Resources- Division of Water Quality f' w . • f [
r"i r r
WELL CONTRACTOR CERTIFICATION # 2869
1. WELL CONTRACTOR:
Bobbie Fowler
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach
NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A - On- Site
OTHER ASSOCIATED PERMIT#(if applicable) N/A
SITE WELL ID #(if applicable) PAS-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection 5I
IrrigationD Other ❑ (list use)
DATE DRILLED 1-4-2012
4. WELL LOCATION:
602 Sunnyvale Dr. 28412
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY NHC
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFlat ❑Ridge DOther
IC di I$TCD 34 innnnffinnnnnnnnl CL ROR 34^1s'B3nnnnn CC
KNMr YTTCD77 IAAAA&AAAAAAAA! CL ROR 77:93448nn10, CC
Latitude/longitude source: MPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
S&R Parkins and Crating 3) C( Z
Facility Name Facility ID# (if applicable)
602 Sunnyvale Drive
Street Address
Wilminaton NC 28412
City or Town State Zip Code
Steve Tyler
Contact Name
804 Porters Neck Road
Mailing Address
Wilminaton NC 28411
City or Town State Zip Code
( 910,6 508-8833
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 39'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
d. TOP. OF CASING IS 2' FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)' N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top 5 Bottom 39 Top Bottom
Top. Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 37 Ft. 1" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 33 Bottom 36 Ft. Bentonite Chi pour
Top 0 Bottom 33 Ft. Grout
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 37 Bottom 39 Ft. 1 in. 0.01 in. PVC
Top Bottom. Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 36 Bottom 39 Ft. #2 Torpedo
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
l �i6
/ stay18'
Formation Description
See attached
RtCE1BEp7NCDEHR/DWg 1 5 2012
12. REMARKS:
MAY 2 2 2017
rs CYBCG
I DO HEREBY CERTIFY THA
15A NCAC 2C, WELL CONST
RECORD HAS BEEN PR
SIGNATUR= OF CERTIFIED
Bobbie Fowler
SIAS CONSTRUCTED IN ACCORDANCE WITH
mNbricui BRAT A COPY OF THIS
ettgVIUL
ELL CONTRACTOR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of Completion to: Division of Water Quality - Information Processing,
1617 Mali Service Center, Raleigh, NC 27699.161, Phone : [phone]
Form GW-1b
Rev. 1/08

43714
NON WELL CONSTRUCTION RECOR�
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3470 A
1. WELL CONTRACTOR:
William Matthew Wiggins
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID Of applicable) Loop 5
3. WELL USE (Check One Box) Monitoring ( Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ( Injection ❑
Irrigation( Other d(iistuse) Geothermal Loop
DATE DRILLED 01/26/2012
4. WELL LOCATION:
6425 Shinnwood Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope (Valley QfFlat ❑Ridge DOther
LATITUDE 34 o 11 ' ammo "DMS OR DD
LONGITUDE 77 " 49 ' 52.0700 " DMS OR DD
Latitude/longitude source: PS ❑ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Al Fulford Heating & Air
Contact Name
3461 Holden Beach Rd SW
Mailing Address
Smolt/
City or Town
(910 ) 842-6589
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250'
NC 28462
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E/
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thicknessl
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 250 Ft. Thermex Tremmie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft.
Top Bottom Ft.
in.
in.
in.
in.
in.
in.
Size Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 25'
25' / 50'
50' / 80'
80' / 140'
140' / 245'
245' / 260'
Formation Description
Silty sands
Clay / shell
Limestone
Clay mudrock
Sandstone
Silty clay
RECEIVED/NCDENR/DWR
MAT -E 2017'
12. REMARKS: ``ttoc,1 'Dirt
1" geothermal HDPE Loop Installed., QU3g'' 'FYC IOnDI
Operations Section •
I DO HEREBY CERTIFY THAT THIS WELLW1kut INl4ayp,E WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDSW"A Nb sATT PWQPv ormiS
REC 2DyASPEEN PRQVIocDTmr' �'� ^�N€R.
01/26/12
SIGNATURE OF CB.RTIFIED W TRACTOR DATE
William Matthew Wi gins
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center,Raleigh, NC 27699-161, Phone :[phone]
Form GW-1 b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3470 A
1. WELL CONTRACTOR:
William Matthew Wiggins
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT/tar applicable)
SITE WELL ID #(if applicable) Loop 4
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery0 Injection 0
Irrigation0 Other deist use) Geothermal Loop
DATE DRILLED 01 /26/2012
4. WELL LOCATION:
6425 Shinnwood Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)•
CITY: Wilmington COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley VFlat ❑Ridge ❑Other
LATITUDE 34
LONGITUDE 77
"DMS OR
" 49 . 51.4600 "DMS OR
t. 11 . 47.5000
DD
DD
Latitude/longitude source: Q3PS DTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
44371•
d. TOP OF CASING IS 0. FT. Above Land Surface*
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 250 Ft. Thermex Tremmie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft
Top Bottom Ft.
Top Bottom Ft.
Size Material
11. DRILLING LOG
Top Bottom
3 i -Ye ( 0' / 25'
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Al Fulford Heating & Air
Contact Name
3461 Holden Beach Rd SW
Mailing Address
Stinnly
City or Town
(910 ) 842-6589
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250'
NC. 28462
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0
NO II
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
25' / 50'
50' / 80'
80' / 140'
Formation Description
Silty sands
Clay / shell
Limestone
Clay mudrock
140' / 245' % A 1 Sandstone
245' / 260' V V Silty clay
/
/ NAY )l d hi!
RECEIVED/NCDENR/DWRN
In
12.REMARKS: Mted 2 2 201,1,
1" geothermal HDPE Loop ins
I DO HEREBY CERTIFY THAT THIS
15A NCAC 2C, WELL CONSTRUCTI
RECOj1D F]Gis,( EN PROV)BED TO T
SIGNATURE OF L`E'RTIFIED
EL
s
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
gmgaR4tsP o0F TFI SE WITH
/T ection
ibnal Office 01/26/12
TRACTOR DATE
William Matthew Wia
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC.27699-161,. Phone ; [phone].
Form GW-1 b.
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3470 A
1. WELL CONTRACTOR:
William Matthew Wiaains
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(If applicable) Loop 3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial ❑ Agricultural El Recovery El Injection
Irrigation[ Other G'(list use) Geothermal Loop
DATE DRILLED 01 /26/2012
4. WELL LOCATION:
6425 Shinnwood Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
cITY: Wilminaton COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope [Valley itlat ❑Ridge ❑Other
LATITUDE 34 = 11 47.7700 " DMS OR DD
LONGITUDE 77 49 ' 51.3500 „ DMS OR DD
Latitude/longitude source: 67GPS propographic map
(location of well must be shown on a USGS tope map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
0(e_
Facility Name Facility ID# (if applicable)
Street Address
City or Town
Al Fulfnrd Heatina & Air
Contact Name
3461 Holden Beach Rd SW
Mailing Address
Sunnly
City or Town
(910 ) 842-6589
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250'
State Zip Code
NC 28462
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO of
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
,143712
d. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top _ Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 250 Ft. Thermex Tremmie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom FL
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 25'
25' / 50'
50' / 80'
80' / 140'
140' / 245'
245' / 260'
/ ffi/tlG
/ MAY 316
12. REMARKS:
1" geothermal HOPE Loop installed
Water Quality Rd' Tonal �l ' RDANCE WITH lE
RgtorrdjpefflC'UHIS
I 00 HEREBY CERTIFY THAT THIS WEL
15A NCAC 2C, WELL CONSTRUCTION 5
RECfdRgJ (BEEN PROVIDE
Formation Description
Silty sands
Ciav / shell
Limestone
Clay mudrock
Sandstone
Silty clav
I MAY 2 2 2017JAN
StIGNATURE OF C RTIFIED die
Matthew Wis. ns
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
"01'2
01/26/12
RACTOR DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617. Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

443711
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3470 A
1. WELL CONTRACTOR:
William Matthew Wiggins
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(91.0 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID#(if applicable) Loop 2
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑
Irrigationp Other 01(listuse) Geothermal Loop
DATE DRILLED 01 /26/2012
4. WELL LOCATION:
6425 Shinnwood Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Cade)
CITY: Wilminaton COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley I 'Flat ❑Ridge ❑Other
LATITUDE 34 ° it 48.1300 " DMS OR
LONGITUDE 77 4e 51.4600 "DMS OR
Latitude/longitude source: Ii;13PS []topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
DD
DD
• 33DCeQ
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Al Fill -ford Heatina & Air
Contact Name
3461 Holden Beach Rd SW
Mailing Address
Sunnly
City or Town
(910 ) 842-6589
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250'
NC 28462
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES p NO d
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
tl. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gem): N/A - METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 250 Ft. Thermex Tremmie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0' / 25' Silty sands
25' / 50' Clay / shell
50' / 80' Limestone
80' / 140' Clay mudrock
140' / 245' Sandstone
245' / 260' Silty
DFCEclavIVFn/Nr.DENR/DWR
MAY 24'
tag, .._
. 'OW/12. REMARKS: e Q n
Water Quality Regional 1" geothermal HOPE Loop Installed c;ritii
WilmiOperation) ts�,ctiar
ngton RJnnal QMCb't`'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC(9.RD Hf BEEN PR VI OWNER.
MAY 16
°1. p7 f Lam% 01/26/12
ATURE OF CERTIFIED WES.L a RACTOR DATE
William Matthew 1�'c•
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2412 A
1. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ii( applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑
Irrigationo Other 0 (list use)
DATE DRILLED 10/29/12
4. WELL LOCATION:
6413 Orange St.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Castle Havne COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley gfFlat ❑Ridge ❑Other
LATITUDE 34 = 21 41.6400 "DMS OR DD
LONGITUDE 77 ^ 53 . 51.2700 "DMS OR DD
Latitude/longitude source: MPS QTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Facility Name
33
Facility ID# (if applicable)
Street Address
City or Town
Chris Set7er
Contact Name
40 Bunn Ave
Mailing Address
Zehillnn
City or Town
( 919 ) 606-1059
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 80'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
c. WATER LEVEL Below Top of Casing: 12' FT.
(Use "+" if Above Top of Casing)
State Zip Code
NC 27597
State Zip Code
443710
d. TOP OF CASING IS 1 5' FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40' METHOD OF TEST Airlift
f. DISINFECTION: Type HTH
g. WATER ZONES (depth):
Top Bottom
Amount , 4161210o/n
Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top +1.5 Bottom 60' Ft. 4"
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0' Bottom 24' Ft. Grout
Top 52' Bottom 56' Ft. Bentonite
Top Bottom Ft.
9. SCREEN: Depth
Top 60' Bottom 80'
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Top 56'
Top
Top
Thickness)
Weight Material
sch40 PVC
Method
Pumped
Pumped
Diameter Slot Size Material
Ft. 4" in.
Ft. in.
Ft. in.
.020 in.
in.
in.
PVC
Depth Size Material
Bottom 80' Ft. #2 Sand
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 20'
20' / 62'
62' / 85'
WG
12. REMARKS:
Formation Description
Sandy clay
Limestone
Sandy sandstone
RECEIVED
NOV 1. 2012
reermation Pre-oos' Unit
MAY 2 2 2017
D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
ORD HAS BEEN 'ROVI]1Ep TO Ep ffa'tity Regional
0s Section
ff 10�/ /�21
SIGNATUR T CERTIFIED 'f ° u;rr -c -+o RI Oa
DATE
Donald H. Cummings
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh; NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION H 2412-A
1. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[,✓ Other ❑ (list use)
DATE DRILLED 05/16/12
4. WELL LOCATION:
710 Kelly Rd.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley grFlat ❑Ridge ❑Other
LATITUDE 34 ° 10 .22.5700
LONGITUDE 77
^ 52 • 32.7100
" DMS OR DD
"DMS OR DD
Latitude/longitude source: VGPS DTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.
Facility Name Facility ID# (if applicable)
Street Address
City or Town
Samir Isir
Contact Name
710 Kelly Rd
Mailing Address
Wilminaton
City or Town
( 910 ) 619-2419
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
State Zip Code
NC 28409
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5y
c. WATER LEVEL Below Top of Casing: 22' FT.
(Use "+" If Above Top of Casing)
443536
-4-0 r 31 3-
d. TOP OF CASING IS 1 .5' FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
G. YIELD (gpm): +$0 METHOD OF TEST Airlift
f. DISINFECTION: Type HTH Amount 3p cat 10%
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +1.5' Bottom 150' Ft. 4" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0' Bottom 24'
Top 142' Bottom 146'
Top Bottom Ft.
9. SCREEN: Depth
Top 150' Bottom 180'
Top Bottom
Top Bottom
Material
Ft. Grout
Method
Tremmie
Ft. Bent. chips Tremmie
Diameter Slot Size Material
Ft. 2" in. .020 in. PVC
Ft.
Ft.
10. SAND/GRAVEL PACK:
Depth
Top 146' Bottom 180' Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 40'
40' / 60'
60' / 90'
90' / 145'
145' / 180'
in. in
in. in.
Size Material
Coarse Sand
Formation Description
Sand fine to coarse grained
Clay
Limestone
Limestone / sand mix
Sandstone
IVED/NCDENR/DWR
'MAY 152017
/ JUq 2 9 _2212
12. REMARKS:
Water Quality Regional at ;
Operations Section
I DO HEREBY CERTIFY THAT THIS JELL WH CONSTRUCTED IIV ACCORDANCE WITH
15 CAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY Of THIS
RC RDHAS BEEN PRQVIDED THEiWELLOWNER.
LL��rrii tt..11,,EE�Z ` ar '`^/a•\ 05/16(12
SIGNATURE OF CERTIFIED WELL CO ACTOR DATE
Donald H Cumminas
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

fj
6.1 ^ 4y �
1 r ONRE'.SIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 3423
1, WELL CONTRACTOR:
WILLIAM T. DUGGINS
Well Contractor (Individual) Name
TERRACON CONSULTANTS, INC
Well Contractor Company Name
5240 GREEN'S DAIRY ROAD
Street Address
RALEIGH
City or Town
(919 ) 873-2211
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
NC 27605
State Zip Code
SITE WELL ID *Of applicable) EI-2011-PZ- SA
3. WELL. USE (Check One Box) Monitoring Bf MuniclpaUPublic 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Infection 0
Irrtgetion0 Other 0 Olst use)
DATE DRILLED 1 la02012
4. WELL LOCATION:
EAGLE ISLAND
(Street Name. Numbers, Community, SubdiNsion. Lot No., Parcel, Zp Code)
CITY: WILMINGTON couNTYNEW HANC61414
TOPOGRAPHIC / LAND SETTING: (check eppro ate box) ,!-
[Mope OValley OFIat ['Ridge Driller b4t�kt"'v(h I
DMS OR B DD
LONGITUDE TS "DMS OR 7 66I� DD
Latitudellongilude source: MPS Dropographic map
(location of well must be shown on a USGS logo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the welt Is totaled.)
Confiners Ilisnosal Facility N/A .30 3
Facility Name
LATITUDE 38 °
N/A
Facility ID# (if applicable)
Street Address
FAGI F ISI AND
City or Town
r
ctr,
a it lit f„tn Avenue
ffMSS
NC'
d
State Zip Code
City or Town State Zip Code
(qlp) 2S`l�
Area code Phone number
S. WELL DETAILS: A 5 t
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gy7
c. WATER LEVEL Below Top of Casing: Zt •5 FT.
(Use °+° if Above Top of Casing)
7. CASING: Depth. Diemet r
Top fi %.i Bottom 417 Ft co
Top Bottom Ft.
Top Bottom Ft.
d. TOP OF CASING IS 3 •2- FT. Above Land Surface*
'Top of casing terminated atlor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER 39NES (dep
Top �%i1' Bottom ' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
Weight Material
8. GROUT: Depth �11 Material
Top 0Bollom 7 / FL ?CC -
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top Tjc BollomAA..[[ Ft. 2 In. 0.'1 in.
Top Bottom Ft. In. in.
Top Bottom Ft. In. in.
10.
To
pve_
Method
7rrwi y
Material
PVC
SAND/GRAVEL PACK:
Depth cSize
P 33 Bottom k + Ft. . Material 54-04)
Top
Top
Bottom Ft.
Bottom F1.
11. DRILLING LOG
Top Boltom Formation Description
o / 3 2- SA'vJD
/
"" 2017 oAY ssog urckt
/ REECEINED/NCDFN��yRPt apG
12. REMARK E 00t OJ
MAY 2 2 2017
sf 1-1-
fkw_P
I WHEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HASE PRO 5P,y(�THE WELL °Walter Quality Regional
LV���Orperations S�,tib2/12
SIGNA'�l1NE OF LEiYllrlt6 WELL UOIYI Wt'I O PgionabAiflte
WILLIAM T DUGGINS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 clays of completion to: Division of Water Quality- Information Processing,
1617 Mall Service Center, Raleigh, NC 27899-181, Phone : [phone]
Form G W-1 b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3470 A
1. WELL CONTRACTOR:
William Matthew Wiaains
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION: ` ,,`
WELL CONSTRUCTION PERMIT# \I )
State Zip Code
co 190
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) LOOP 1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑
IrrigationD Other d(listuse) Geothermal Loop
DATE DRILLED 01 /26/2012
4. WELL LOCATION:
6425 Shinnwood Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Han.
TOPOGRAPHIC / LAND�SETTING: (check appropriate box)
❑Slope ❑Valley �e Flat ❑Ridge ❑Other
LATITUDE 34 011 ' 48.1700 ^ DMS OR DD
LONGITUDE 77 ° 49 ' 51.7000 "DMS OR DD
Latitude/longitude source: ZIPS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
S31LQ
• Facility Name Facility ID# (if applicable)
Street Address
City or Town State. Zip Code
Al Fulford Heatino & Air
Contact Name
3461 Holden Beach Rd SW
Mailing Address
Sunnly
City or Town
(910 ) 842-6589
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250'
NC 28462
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Gif
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 250 Ft. Thermex Tremmie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft.
Top Bottom - Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 25'
25' / 50'
Size Material
Formation Description
Silty sands
Clay / shell
50' / 80' Limestone
80' / 140' Clay mudrock
140' / 245' Sandstone
245' / 260' Silty clay
/ WG
4.!(.Y 16 2t wcvcteCD/rytiUttretc/UI/IC
).\ 6
12. REMARKS: MAY 2 2 20
1" geothermal HDPE Loop installed
100 HEREBY CERTIFY THAT THIS WELIWat�rrStltldt niTgLegiOn0eRDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STA an' ; r@ii4NE5T6@UtigiFY OF THIS
REC• Rp ;.S BEEN P-•VID . TO,c I..t - Regional Office
SIGNATURE O C RTIFIED r uNTRACTOR 01 DATE[
ins
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
sr,
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

WELL CONSTRUCTION ILECORI.)
Print form
Inlernnl !ise Onhz
9 8
1. Well Contractor lnlunmaMon:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit 0: N/A
L,isl all applicable well constructionpemals (t e WC, County, State, Variance, etc.)
3. Well Use (cheek well use): )
14. WATER ZONES
FROM
'1'O
DESCRIPTION
ft.
ft.
R.
ft.
15. OUTER CASING (for multi-easedwells) OR LINER of ap licable)
FROM
TO
DIAMETER
THICKNESS MA rERIAL
0 ft
20 R
2 q.
SCH40 PVC
16. INNER CASING OR TUBING (geothermal :elosed loopL
FROM
TO.
DIAMETER
THICKNESS
MATERIAL
in:.
!.
rt.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE THICKNESS.
MATERIAL'.
20
60 rt
2 "
010 SCH$0
P1/C'
R
ft
rry
s's,
\IS. GROUT 4 t .,s
.s .'+,.i
<'aPizl'.;n1;L'$a.4d$3;�P tr
PROM
,, TO' -
MATERIAL EMPWCEIMEtltMETH0 3,CAM()
0 ' It
" 1' a
Grout
P Q ureds ,xt ,
'. ea � w•'if�
1 ft
17 ft
Bentonite
Poured k ty,,Ar1 .
t
ft.
ffi:SAND/GRAVEta EACK(ifapplicnble)
'
FROM
TO
MATERIAL
EMPLACEMENT METHOD
17 ft
60 ft
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (atta
h nddifionsl sheetsifnec scary)
FROM
TO
DESCRIPTION Motor, ho,dovs, soil/rock type, groin sae, ere)
ft.
ft
See Attached
ft.
ft.
ft.
ft.
ft
ft.
ft.
ft
ft.
ft.
ft.
MAY 2 0 017
21.REMARKS
.nn , In
EbidCliBOG
Water Supply Well
Agricultural
Qeothenmll (Heating/CcolmgSupp
irdustnal/Comhtercf al
kionitonng
Injection Well
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Groundwater Remediation'
®Salinity Barnet
fStormwater Drainage
Subsidence Control
Tracer
Other (explain under 1121 Remarks)
4. Date \Yell(s) Completed: 4/12/17
5a. Well Location:
Invista
Well ID#AM W-8
N/A
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 18 40.49 N 77 58 47.81
W
6. Is(are) the well(s)J% Permanent or ['Temporary
7. Is this a repair to an existing well: DYes or x®No
1f this is a repair, fill out known well construction information and explain the nature of the
repair under e21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 60
For multiple wells list all depths if different (example- 3@200' and 2(at o0')
10. Static water level below top of casing: 9.99
If water level is above casing. use �"
11. Borehole diameter: 6 Mud
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable. direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
22. Ce - Hinton:
d
4/12/17
Signature of Certified Well Contractor Date
By signing this form, / hereby certify that due we/l(r) was (were) constructed in accordance
with /SA NCAC 02C .0100 or 15A NCAC 02C .020) Well Construction Standard and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back p@pflt cj iy1.t e t iURI well site details or well
construction details. Y ^a7sb'3(thbl{.ea tea pages if necessary.
SUBMITTAL INSTRUCTIONS'l [[ qq((11 7
24a. For All Wells: SubmMAYs JBr1N v2Mit 30 days of completion of well
construction to the following:
Division of WatliAlagrolhaVitlatgiINB611 Processing Unit,
1617 Mail SerepetAigutb timoNC 27699-1617
Wilmington Regional Office
24b. For Iniection Welts: in a0fditiOn to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AWW-8
Drilled by: Applied Resource Management
Logged by J. Zuncich
Date: 4/12/17
M
Uepfh
+ st 'yf�//✓.,z i�t s
y'+ J4 ".•%§+i'
SS
y i aaa� i r f(µ L�'h✓ e? T ^' 65 i kes�\�'35MJ•� ti
r �r 5 Descnpton' r°� E n t
- at 1 a 41y�i�: aA.G �,x wa*ry s e�rc. dti�, +�,a ;+° �,„�jv,, .'4,ra `+E"g ££,.,
��r's�-�y�;py s's '�'1 3' n eV n`R.k� � "`Fi}5tr ra cP�"o4.'.
�nJs� �
y=ryry
titer
:gym
-efi,.
+� low
ount
0 - 10
Light gray, medium to coarse grained sands changing to dark
brown, fine to coarse sand mixtures with some organic matter.
No hydrocarbon odor.
Low
MR
10 - 25
Dark brown, medium to coarse grained sands with light gray,
clay tense found at approximately 24' deep. No Hydrocarbon
odor.
High
MR
25 - 40
Gray brown, coarse to gravelly sand mixtures. No
Hydrocarbon odor.
High
MR
40 - 55
Brown to beige, medium to coarse sand mixtures with minor
gravelly sand material changing to dark gray, fine to medium
grained sands at approximately 48' deep. No Hydrocarbon
odors.
High
MR
55 - 61
Dark gray, fine to medium grained sands changing to dark
gray, brownish orange, silty clay at approximately 60' deep.
No Hydrocarbon odor.
High
MR
MR = Mud Rotary

Protective Steel
Stand Pipe
Ground Surface
0' - 1' Grout
AMW-8
•
4
1 1
♦t •♦.g..
♦s••
♦' DTW-9
17' Bentonite'e♦4 ♦•i
,.Z :i •
1•••. '•••
• • • 1 • • •
••••4_ •• • ••
i••• 4 '•••
1•i•• • 4 'iii
1 • 4 1 'iii
1••u '•••
•i•i •••••
• • • • • •
•••• 1••••
i•%i • i••
•
17' - 60' Sand ••:•:• ••:•:
••4 '
I• ••• •
':. • •' •
• •••4 .
'••4 '.•:•
••• •_
60' Total Depth
2.5' Stick Up
0' -. 20Riser
1
20' - 60' Screen
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
-1%14\
Applied Resource
Management, P. C.
Hampstead, NC 2844.3
TITLE:
As -built for AMW-8
JOB:
10038
SCALE:
NTS
DATE:
5/04/17
DRAWN BY:
JLZ
FIGURE:

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit If:
N/A
List all applicable well construction permits (-.e UJC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water. Supply Web:
x.. Monitoring
Municipal/Public
Residential Water Supply (single)
(Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed:,4/1 1 /17
5a. Web Location:
Invista
Groundwater Remediation
Salinity Barrier
fStonnwater Drainage
Subsidence Control
DTracer
Other (explain under #21 Remarks)
Web ID#AM W-7
N/A
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. I=BrN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latfong is sufficient)
34 18 40.55 N 77 58 55.92
w
6. Is(are) the well(s)Dx Permanent or DITemporary
7. Is this a repair to an existing well: 3Yes or QNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this forth.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 60
For multiple wells list all depths of different (example- 3@200' and 2@1001)
10. Static water level below top of casing: 10.12
If water level is above casing, use "-"
11. Borehole diameter: 6 (in.)
12. Web construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
136. Disinfection type: N/A
Amount N/A
For Internal Use Only:
143,.
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
it
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft
20 11-
2 n
SCH40
PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft,
in.
ft.
ft.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
20 fh
60 ft.
2 'n'
.010
SCH40
PVC
ft.
fr.
in.
18. GROUT'
FROM
TO
MATERIAL
EMPLACEMENT MErI OD & AMOUNT
0
a ft
Grout
Poured
1 ft-
17 fL
Bentonite
Poured
ft.
£t.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
17 ft'
60 fL
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if necessary).
FROM
TO
DESCRIPTION (color, hardness, soil/ och type, gnin size, He.)
it,
ft
See Attached
ft.
ft.
ft.
ft.
R.
ft
ft.
ft.
g h
fL
ft.
MAY 1 0 201/
21. REMARKS
htesrlarailOD r'rGoercr line(
p�^r'C.N6A�
22. Certir ation:
4/11/17
Signature of Certified Well Contractor / l Date
By signing this form. / hereby cert@ that the well(s) w . (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standard and that a
copy of this record has been provided to the well owner. ,
23. Site diagram or additional well details:
You may use the back of this1�kIt page to provide additional well site details or well
construction details. IfGemE &7ototimages if necessary.
SUBMITTAL INSTRUCTIONS 11t�11����I�L
24a. For All Wells: Su mritythil frn' itUtifttin 30 days of completion of well
construction to the followi ff�fl 11 eL I I
Division of Water Resources, Information Processing Unit,
1617 MM IIS*MfiQUaiitptRatiins4, NC 27699-1617
Operations Section
24b. For Infection Wtl(rji t8 j(ie@i(yrini�e forth to the address in 24a
above, also submit one copy of this Mum within 0 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water SUMD&V & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of web construction to the county health department of the county
where constructed.
Form GW-1
Department of Environmental Quality -Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AWW-7
Drilled by: Applied Resource Management
Logged by J. Zuncich
Date: 4/11/17
iDeepth ^
'. Description
*"Wafth� gt,
a°nCon te,4W9bt
` io
0 — 10
Gray to dark brown, medium to coarse grained sands with
some organic matter. No hydrocarbon odor.
Low
MR
10 - 25
Gray to dark brown, medium to coarse grained sands changing
to light brown, coarse to gravelly sand mixtures at
approximately 21' deep. Light gray brown, clay tense found at
approximately 24' deep. No Hydrocarbon odor.
High
MR
25 - 40
Tan to beige, coarse to gravelly sand mixtures. No
Hydrocarbon odor.
High
MR •
40 - 55
Tan to beige, coarse to gravelly sand mixtures changing to
dark gray, fine to medium grained sands at approximately 53'
deep. No Hydrocarbon odors
High
MR
55 - 60
Dark gray, fine to medium grained sands changing to dark
gray, silty clay at approximately 59.5' deep. No Hydrocarbon
odor.
High
MR
MR = Mud Rotary

Lock -
Protective Steel
Stand Pipe
Ground Suroce
0' - 1' Grout
60' Total Depth
20' - 60' Screen
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
--4141\
Applied Resource
Management, P.C,
Hampstead, NC 2@443
TITLE:
As -built for AMW-7
JOB:
10038
SCALE:
NTS
DATE: (DRAWN BY:
5/04/17 JLZ
FIGURE:

Print Form
WELL CONSTRUCTION RECORD (GW l
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (ix. (WIC, County Stale,.Variance , et
3. Well Use (check well use):
.Water Supply Well: S
Agricultural
eothermal (Ueatmg/Gooling,,
ndustnal/Con me�ciahi,
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
eco
Groundwater Remed i ation
JSalmny Barrier
fStormwater Drainage
Subsidence Control
0Tracer
Other (explain under #21 Remarks)
4. Date Weil(s) Completed:4/1 1 /17
5a. Well Location:
I nvista
Well ro#AM W-6
N/A
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
For Internal Use Only:
3
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
rt.
ft.
15. OUTER CASING (for mulfi-eased wells):OR LINER (if aP licable)
FROM
TO
DIAMETER
THICKNESS I MATERIAL
0 ft 21 ft 2 SCH40
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
PVC
MATERIAL
ft.
ft.
111
L
in.
21 ft.
HOG
2
010i
THICKNESS
SCH40,;
g9;&`k0agsSc a*ri�i3ra2,'v~ri'u *.-3YFC*t• eft s.-t'�ZTHOD .M4
£MPIACEMEt1T'.ItEPRODAA140/1 Y.k
MATERIAL
ou7
r4
Poured' -"
Poured
19. &SINEW& VEL PAC
FROM
TO
MATERIAL
EMPLACEMENT METHOD
18
61 ft-
Coarse
Poured
ft.
ft.
20. DRILLING LOG (arta h additional sheets if necessary)
FROM
ft.
TO DESCRIPTION (color, hardness, soil/rock type, onto size, etc)
ft See Attached
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. (N)
a
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 18 42.46 N 77 58 55.38
W
6. !spire) the well(s) Ix Permanent or DTemporary
7. Is this a repair to an existing well: ®Yes or ONo
If this is a repair, fill out known well construction information and explain the native of the
repair under #21 remarks .section or an the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: I
9. Total well depth below land surface: 61 (ft)
For multiple wells list all depths if ((efferent (example- 3@200' and F&100')
10. Static water level below top of casing: 10.59 (ft.)
lfwater level is above casing, use "'-"
11. Borehole diameter: 6 r1 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/'4 Amount: N/A
ft.
ft.
Mikt 0 2017
21. REMARKS
h
22. Cert. - • tion:
Signa ure of Certified Well ontract
orAz % ate'
4/11/17
Date
By signing this farm, I hereby cert fy that the well(j was (were) constructed In accordance
with I5A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been prREdf1vEo1FiODENRIDWR
23. Site diagram or additionalwelldetails:��l`
You may use the back of this page to provide additional well site details or well
construction details. You may alsOych d&tiNgages if necessary.
SUBMITTAL INSTRUCTIONS aI
24a. For All Wells: SubmiANAtefethl&ihtt}(iPi q®I®0gs of completion of well
construction to the following: OperatIOnS Section
W�/dilmington Regional Office
Division of Water Resources, lnformatioo Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Iniection Wells: In addition to sending the fonm to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where c nstructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AWW-6
Drilled by: Applied Resource Management
Logged by J. Zuncich
Date: 4/11/17
De th
e3.5
a'.Yy����ic,.f Nk}Sii4Yj
Descn�tron b�',
FV. 'ff
s21"S ¢4IjY' KI .�Y'j�{M., v3.: 1 '.. Y1,1 S 5:`'4s+'_£t'��Ykcp'ty-y 11'y�w
we j
$ /r Q
4ct^V�%�H
B 4j
r��96YuR€ tit
0 - 10
Gray to dark brown, fine to medium sands coarsening at
depth. No hydrocarbon odor.
Low
MR
10 - 25
Medium brown, fine to coarse sand mixtures changing to tan-
beige, coarse sands. No Hydrocarbon odor.
High
MR
25 - 40
Tan to beige, fine to coarse sand mixtures with a light gray,
silty clay tense at approximately 28' deep. No Hydrocarbon
odor.
High
MR
40 - 55
Light brown to beige, fine to coarse grained sand mixtures
changing to dark greenish gray, fine to medium grained sands.
No Hydrocarbon odors.
High
MR
ib
55 - 62
Dark greenish gray, fine to medium grained sands changing to
dark gray, silty clay at approximately 61' deep. No
Hydrocarbon odor.
High
MR
MR = Mud Rotary

Lock
Protective Steel
Stand Pipe
Ground Surface
s
0' - l' Grout
s
AMW-6
61' Total Depth
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
Applied Resource
Management,
Hampstead, NC 2
P. C.
ean�
TITLE:
As -built for AMW-6
JOB:
10038
SCALE:
NTS
DATE:
5/04/17
DRAWN BY:
JLZ
FIGURE:

Print Form
WELL CONSTRUCTION RECORD (6 -I)
I. Well Contractor Information:
Donald Cummings
Well Contractor Narne
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name:
2. Well Construction Permit #: N/A
by all applicable wet! construction permits Pe. WC, County, Slate Variance, etc)'
3. Well Use (check well use):
Agncuituml
Geothemtal (Fleatmg/Cooling Su
Industrial/Coniinercial
Imgatioa
on Water SNpply'WeQ -!
htlonitOring
:jection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 4/10/17
5a. Well Location:
Invista
®Groundwater Remediatron
°Salinity Barrier
fStormwater Drainage
°Subsidence Control
°Tracer
Other (explain under #21 Remarks)
Well m#AMW--5
N/A
Facility/Owner Name Facility IDk (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover R02400-001-001-000
County Parcel Identification No. agrees:
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Tat/long is sufficient)
34 18 41.74 N 77 58 42.39
W
6. Is(are) the well(s)fIx Permanent or f__YTemporary
7. Is this a repair to an existing well: ©Yes or x®No
Iftbis is a repair, fill nit known well construction information and explain the nature of the
repair under 121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: I
9. Total well depth below land surface: 55
For multiple wells list all depths. if different (example- 3@200' and 20100')
10. Static water level below top of casing: 10.25
(ft.)
!f water /evel is above casing, use "w"
11. Borehole diameter: 6 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
nternal Use Only
14 5
14. WATER ZONES
FROM
TO
DESCR/PITON
ft.
ft.
FROM
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (f rap rI'cae bl )
THICKNESS MATERIAL
TO
DIAMETER
0
15
2
SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO DIAMETER THICKNESS
ft.
in.
IATERIAL
15'a
ft
TO
55
ft
fc>
`IttFCROtti rIIII d3
:TO it.
1
ft.
m
SSLOtSIZE4r
dAl
Bentonite
010'
SCH40
PVC
.HEM2EACEMENC-.METROD.&AMOUNNv"
•o,y
OUff
Poured
ft ss
19):SAND/GRAYELPACK (if applicable)
FROM
12 ft-
TO
55 ft.
MATERIAL
Coarse,
EMPLACEMENT
Poured
OD
rt.
fL
20. DRILLING LOG (atta b additional sheets ifnecessary)
DESCRIPTION (color, hardness, soil/rock type, grain size, etc)
FROM
TO
0.
See Attached
ft.
ft.
ft.
Ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
MAY g62
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: NIA
22. Certific 4'on:
L
Signat e oCertified Well Contactor
By signing ibis form, 1 hereby certify that the well(s) was (were) constricted in accordance
with ISA NC'AC 02C .0100 or !SA NCAC 02�C('��.0°200 Well Construction Standards and Mat a
copy of this record has been priij(gQ fgjllr'U11r4��NRIOW R
23. Site diagram or additional well
details:
You may use the back of this page to provide additional well site details or well
construction details. You may alsplajtrh$ditippjl, gages if necessary.
SUBNIITTAL INSTRUCTIONS
11 11 LL UU III
24a. For All Wells: SubmiarrmattpiR6,3061m of completion of well
construction to the following: Operations
,.Section
fF
Division of WateWlillil Vil ril u�gi iliin`i'tgssing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
constniction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
4/10/17
Date
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AWW-5
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date. 4/10/17
Depth
f fr is
S
) F .y.d�N'1 �•
x Descnphon ,
C', q 3 F i.f t! �'�.
?E�.��'...';.p.t a�.°az
"t,^'
A
Y
ter
on 14,
Cey+tfi?.
Bty
0
0 - 10
Gray brown, medium to coarse sands with minor gravelly sand
mixtures. No hydrocarbon odor.
Low
MR
10 - 25
Tan to light brown, coarse sands grading to gravelly sand
mixtures at 20'. No Hydrocarbon odor.
High
MR
25 - 40
Light brown, coarse to gravelly sand mixtures changing to
medium gray, fine to medium grained sands at 39'. No
Hydrocarbon odor.
High
MR
40 - 55
Brown to gray, medium to coarse grained sands changing to
dark gray, silty clay at 54'.
High
MR
MR = Mud Rotary

12'-55'Sand ••••:
• ••
•
• • ••••
•••
•
•••
•••••
•'•_
AMW-5
Lock
Protective Steel
Stand Pipe
Ground Surfa e
0' - 1' Grout
41
• • _ e ►®�.--1
° •
• i
__ 4_ : e�
3' Bentonite �0 4 ID 10.25'
14••4 !• •
♦
2.5' Stick Up
0' - 15' Riser`
:z• •
J •.•> l
less °•e
•lie °• •• ••
�••• I•••
•• •• .S ••••
•••. ••••
•
••• 4 °•••••
•••••••• I•••••
iii iii0
i•0 iii.
••0 •ii.
•••• °•ii•
* fb ••••••
••• •41 1 5' 55' Screen
•° • • •
•
••�•••
°•.• ••
°•••
• ••• •••
• Oa ° ill
�•i• �•••�•i•i
•••••••i
55' Total Depth
•
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
-silt\
Applied Resource
Management, P. C.
Hampstead. NC 28443
TITLE:
As -built for AMW-5
JOB:
10038
SCALE:
NTS
DATE:
5/04/17
DRAWN BY:
JLZ
FIGURE:
1

Print Form'
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2 Well Construction Permit #: NA
/
Ltst all applicable well construction permits (1. e. IJIC, County, S'/are, Variance. etc.)
3.. Well Use (check well use):
Water Supply Well:
()Agricultural
`Geothermal (Heating/Cooling Supply
IndusMelJCcmrp&olal
rrigatlon 5-
Water1Supply.W
XtMonitoring
Injection Well:":
®Aquifer Recharge
Aquifer Storage and Recovery
Aquifer "Pest
Experimental Technology
Geothemlal (Closed Loop)
Geothermal (Heating/Cooling Remm)
ecgvery+
®Groundwater Remediahon
DSalinity Barrier
EJStormwater Drainage
Subsidence Control
()Tracer
Other (explain under I/21 Remarks)
4 Date Well(s) Completed: 4/6/17
3a. Well Location:
Invista
Well ID#AM W-4
NIA
Facility/Owner Name Facility IOU (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. (PIN)
if
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i Ewell field, one lat/long is sufficient)
34 18 38.48 N 77 58 45.97
6. Is(are) the well(s)[JlPermanent or ■ITemporary
7. Is this a repair to an existing well: fYes or ®X No
If this is a repaiq. fill out known well cons/reection information and expla
repair under 121 remarks section or on the hack of this form.
le nature of the
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 59 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2Q100')
10. Static water level below top of casing: 10.18
(ft.)
If water level is above casing, use "-"
11. Borehole diameter: 6 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable. direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
f-or Internal Use Only:
44s5
14. WATER ZONES
FROM
TO
DESCRIPTION
1't.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased webs) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 ft'
19 ft.
2 in.
SCH40 IPVC
16. INNER CASING OR TURING.(geothermal
closed loop)
FROM
TO
DIAMETER
:THICKNESS
MATERIAL
ft.
ft.
m.
.i
ft
ft
N.
17.SCREEN *wit. ,1.,
-FROM
TO
DIAMETER
SLOT SIZEf
THICKNESS-' MATERIAti:
19 It
59 It
2 I
0:
scH4o PVC
in.
4' yyfe..'r
^V 01tOU
)1..
�li.r'i ?e 63
�n yt
bigot. fAM1t- '
y�.�y p
r R^ atliK a'.j'.e. J.
lAFROMr..
TOx t
MATEItIMF n
EMPEACEmENt'MECH°D&,AM02'/19Z
b t;
11q,
Grout,
pourefl ;'
1 , 'ft
16' ft
Bentonite
Poured avr;.
R
ft.
19. SAND/GRAVEL PACK
(ffapplcable)
FROM.
TO
MATERIAL
EMPLACEMENT METHOD
16 ft
59 k.
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if nee ss ry)'
FROM
TO
DESCRIPTION (colon, hardness, eo,l/rock type, gi amsrre, etc.)
ft.
ft.
See Attached
ft.
ft.
ft.
ft.
ft.
ft.
r.
ft.
• p{ y ssn17
ft.
ft.
21. REMARKS 'ivik,rmatinn Pro'. a&SW-r;V ';Yob.
OWQ/BOC
22. Ce• ion: /J
Sigr amre of Certified Well Contractors
4/6/17
Date
By signing this form. 1 hereby certify that the well(s) was (were) constructed in accordance
with LSA NCAC 02C .0100 or IBA NCAC 02C .0200 Well Cunsen:diem Standards and that a
copy ofthis record has been provided to the well owner.
23. Site diagram or additional , GPYiIP/NCDENR/DWR
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
MAY 152017
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days, of completion of well
construction to the following: Water Quality Regional
Operations Section
Division of Water Restyljtllytkrforpt�BglpRelh tegUnit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AWW-4
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date:4/6/17
' TMt
Depth
S�h Y'�
+A
aT x r k f l9
+.� Description
k � t-, .� ..5- f - yi4y i i
S ,�x
Wa er4
f /`+k14
{{ nWYr
0n},en}`u kMv'
'Bi ri j
slow
jVor/n4ta'i
babf�i'n%-ash,
0 - 10
Grayish brown, medium to coarse sands changing to tan
brown, fine to coarse sand mixture with some organics. No
hydrocarbon odor.
Low
MR
10 - 25
Light brown, fine to medium sand grading to coarse, gravelly
sand at 22'. Thin gray silty clay tense at 18'. No Hydrocarbon
odor.
High
MR
25 - 40
Tan to beige, medium to coarse sand, some gravelly mixtures.
No Hydrocarbon odor.
High
MR
40 - 55
Tan to beige, medium to coarse sand with some gravelly
sands changing to fine to medium gray grained sands.
High
MR
55 - 60
Medium gray, fine to medium grained sands, changing to gray
silty clay at 59'.
High
MR
MR = Mud Rotary

Lock
Protective Steel
Stand Pipe
Ground Surface
0' - 1' Grout
AMW-4
immansi
1' - 16' Bentonite►�••�
••.. ,..
• ••• •••
I• ••• •i '.•• •
• .. • • o
I •••• ••••••
i••• o 'iii
iii. 'iii
i...0...
0004 '...
.•.•! 'iii
• . • 1 o . r
!• •. '•••f• 19' - 59' Screen
16' - 59' Sand lee. i.• .
1•.• • : •••• .•
. •.' 1 S'••
•• •. .•.•
• . • I..!.
••• •••
•
2,5' Stick Up
•
0' - 19' Riser
59' Total Depth
l
A
V
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
--41114\
Applied Resource
Management, P.C.
Hampatead, NC 28443
TITLE:
As -built for AMW-4
JOB:
10038
SCALE:
NTS
DATE:
5/04/17
DRAWN BY:
JLZ
FIGURE:
1

CONSTRUCTION RECORD
PYill t Form
For Internal Use Only:
I. Weil Contractor information:
Donald Cummings
Well Contractor Namc
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:' V/A
Lis! all applicable well construction permit' (i.e. 1f1C, County, State, Variance, etc..)
3.: Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Suppl?
Industrial/Commercial
Ration -
ater8upply Well:
1xjIvtonftoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Recovery
OGroundwater Remedmton
OSalmity Barrier
fStormwater Drainage
Subsidence Control
fTracer
`'Other (explain under #21 Remarks)
4. Date Well(s) Completed: 4/6/17 Well mMAMW-3
5a. Well Location:
Invista
N/A
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. (SIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lal/long is sufficient)
34 18 39.64 N 77 58 40.66
W
6. ls(are) the well(s)4x Permanent or ['Temporary
7. Is this a repair to an existing well: QYes or EINo
ftlds is a repair, fill out known well coosmuction information and explain the nature of the
repair under' 2I remarks .section or on the back of this. form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 58
f? r multiple wells /is all depths if dii ferent (sample- 3@i 00' and 20.100')
10. Static water level below top of casing: 1 1' 32
Iffmter level is above casing, use "-'
II. Borehole diameter: 6 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable. direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
14. WATER ONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (formulti-cased weils):OR LINER (if applikable)
FROM
TO
DIAMIETER
THICKNESS MATERIAL
0 IL
18 It
2 im
SCH40
PVC
16 INNER
CASING OR TURING.(geotheimal
closed loop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
17. SCREEN
ri,
FROM
TO
DIAMETER
SLOT SIZE f:THICKNESS
MATERIAL=;
18 ` ft
58 It
2 ""
010 -
SCI-j40
v.
ft.;
.fr.
in.
>'d8:`;RROCrT'?''+s°N�`':4'l'karma'r^".,7;awk`''kffa?fvrr.S.fi..V,
.YssiIA 3,mr.,�re �C.1
.NRO 1
a'O +
i,1fA?EREM
"FIDPLAC t1D&AMQD
ti7r0,(it a
:`POUr�dt f et,t. l4xI F:F
`1. `
Berltonite
' Poured
ft
ft.
.19: SAND/GRAVEL PACK
(ifapplieabto) ; C I
FROM
TO
MATERIAL
_ EMPLACEMENT NIECHOD
15 tL
58 ft
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (atta
Is additional sheep if necessary)
FROM
TO
DESCRIPTION (color, brutes; soil/roeklype,grain siize,etr)
it.
ft.
See Attached
ft.
ft.
ft.
R.
ft.
ft.
u:
I,sp 9 g
ft.
ft.
2017
h.
ft.
MAY 10
21. REMARKS ,,,;,.,)y.,,fq us �', m..niL.
22. Certi tion:
Sibs t ertlfied Well Contractor
4/6,0,9 4/6/17
J Date
fly .vigning this form, 1 hereby curia} that the well(s) was (were) constructed in accordance
with GA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of/his recant has been prm rllly,/�tKyrt(l ¢u r2e�ENR/DWR
23. Site diagram or additional wellelVdeetaaiillsN:4
You may use the back of this page to provide additional well site details or well
construction details. You may alsggt[arh aalditionall pages if necessary.
SUBMITTAL INSTRUCTIONS j 1
24a. For MI Wells: Submit effma lt.irk0 10aDyal of completion of well
•
construction to the following: Operations Section
Division of WaterftUd 9,,Rri fallah(I){r6asing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnis: & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-I
North Carolina Department of Environmental Quality -Division of Water Resources Revised 2.22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AWW-3
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 4/6/17
tie,
ff) a
Description
"
Water
Content
Blow
Count'
0 - 10
Tan to grayish brown, fine to coarse grained sand mixture. No
Hydrocarbon odor.
Low
MR
10 - 25
Light brown, medium to coarse grained sands. No
Hydrocarbon odor.
High
MR
25 - 40
Tan to brown, fine to coarse grained sand mixtures with minor
gravelly sand. No Hydrocarbon odor.
High
MR
40 - 56
Tan to brown, fine to coarse grained sand mixtures with minor
gravelly sand changing to medium gray, fine to medium
grained sands.
High
MR
56 - 60
Gray sands changing to silty clay at 58'.
High
MR
MR = Mud Rotary

Lock
Protective Steel
Stand Pipe
Ground S rf e
®_
0' - l' Grout
issimane
Email
. •
•
r0••I )•,♦,
•
15' Bentonite�•♦•1 ►•
AMW-3
2.5' SIiick Up
vex -. r
••• • •.
•!•••• '•••••••
•
..• ►•••
15' - 58' Sand
a
�•••
ram• • • • •
•_•_• i•••i
►•••
►•••
•
►i •••
•••••
••
••• • •• 1•:•: •:
•••• '•••
•
• i••
•••
100000.
•••
•_•••••••• •••• • I
58' Total Depth
18' - 58' Screen
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17,
--**3/44‘
Applied Resource
Management, P.C.
Hampstead, NC 28443
TITLE:
As -built for AMW-3
JOB:
10038
SCALE:
NTS
DATE: DRAWN BY:
5/04/17 JLZ
FIGURE:
1

Print Form
NEB? CONSTRUCTION RECORD ([ 1V±
1. Well Contractor information:
Donald Cummings
Well Contractor Name
2412-A
NC' Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County. State, ✓arianc
3. Well Use (check well use):
N/A
tc)
Water Supply Well:
0Agriculturai.
®Geothermal (Fleating/Coolrng Supply) „-
Industrial/Commercial •,
Irrigation;,
uu Water Supp
Monitoring y
1jeetion Well. , Fl yv , -
AgmferReclarga � , aI GfaundwaterAemedtatibn
Aquifer Storage and Recovery; bSalinity Barrier
Aquifer Test ,fjstonnwater Drainage
ilsiante Con
Municipal/Public
IRestdenpal Water Supply (single)
Water SuQpiy (shared)
perlmental Technology .. S b 'd
othermal (Closed Loop) - ,Tracer
jjEx Control
jo• e
aliGeothermal (Heaung/Cooting Return )' :fOther(exp
4 Date Well(s) Completed: 4(5�17 Well m#AM W 2
5a. Well Location:
Invista
Facility/Owner Name
4600 US Highway 421 N,;
N/A
lain under #21 Remarks)
Facility Mg (if applicable)
Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County - - Parcel Identification No. (LAN)
5b. Latitude and longitude indegrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 18 24.50 N 77 58 56.50
6. Is(are) the well(s)(Permanent or ®ITemporary
7. Is this a repair to an existing well: )Yes or EINo
If this Ls a repair. fill out known well construction information and explain the nature of the
repair under #21 remarks section or an the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 49
For multiple wells list all depths if different (example- 3 rt 00' and 2@100')
10. Static water level below top of casing: 16.24
!/'water level is above casing, ime "-"
11. Borehole diameter: 6 (in.)
(ft.)
(ft.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: NIA
13b. Disinfection type: N/A Amount: N/A
Infernal Use Only:
43,
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CAS/NG (for muld-cased wells) OR _LINER Of ap dicable)
FROM
To
DIAMETER
THICKNESS
MATERIAL
0 ft.
9 ft
2 „
SCH40
PVC
16. INNER CASING OR TUBING.(eothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft
ft.
n
17-SCREEN: xzs: :w
_rt
_FROM
TO
DEAME ER
SLOT,SIZEL -THICKNESS:•
MAtER1Ar :y .
9 ft
49 g.
2 'a
olt) se0 °
ft
ft
IIL
"1a.-GRO1PL- 4.,4
.eta 't sisisv#�
FROM
TO .
Y• .tMA'l'ERTAL.,;:z
HEMP" otanatrt on,:&yAMOUN.L";,
0 ft
1 ft-,
,Gro`ut ,`
dad wx
Poui
��d „`��1��qv
i°s��t
1 ft
7 t
Bentoniite
'Poured' "'
fr.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO '.
'MATERIAL
EMPLACEMENT MEI•HOD
7 ft•
49 ft
Coarse
Poured
ft
ft
20. DRILLING
LOG (attach
additional sheen ifnecessary) '.
FROM
TO
DESCRIPTION (color, ia,Uness, soiVrnck type, gram size, etc.)
ft.
ft
See Attached
ft.
rt.
ft.
ft.
ft
g aq
f[.
ft.
. .1/4 I- b,s S..e, a rr T i6n
ft.
ft.
MAY 1 0 2017
ft.
ft.
l%r
21. REMARKS nY+'lffii1tsi: l':':..r:J;tl'y
I.)I:I14).iYti.Y
22. C
4/5/17
Signature of Certified Well Contractor I / Date
By .signing this farm, 1 hereby cern & that the well(r) was (were) constructed in accordance
with 15A NCAC 02C .0100 or /SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been4rovideel to the well owner.
23. Site diagram or ad CRPAC ENR/DWR
You may use the back of this page to provide additional well site details or well
construction details. You ma allsoo attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS' 1 5 201/
24a. For All Wells: Syi?mit this tons within 30 days of completion of well
construction to the follow e7ter Quality Regional
�perationsSeection.
Division of (jtpnif}gtgfirRyi tp13 n Processing Unit,
1617 Mail Service Cente , a eig u 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Font GW-I
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

BORING LOG
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AMW-2
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 4/5/17
DEPTH
4 i }
ESCDRIPTION
f7aa
ftl ] S }
t WATER
�r+�tx ih et
i.
CO I�Te4T
, 4$Y tiisaiRi,
BL W
L2i .lm�
COS
Amaza"t i.
o - 10
Light gray to brown, fine to coarse grained sand mixtures with
some organics. No Hydrocarbon odors.
Low
MR
10 - 25
Tan brown, medium to coarse grained with some gravelly
sands. Thin light gray, clay tense at 19'. No Hydrocarbon odor.
Moderate
to High
MR
25 - 40
Light brown to beige, coarse to gravelly sand mixtures. No
Hydrocarbon odor.
High
MR
40 - 49
Tan brown, fine to coarse grained sands grading to a dark gray,
silty clay at 48'.
High
MR
MR - Mud Rotary

Lock
Protective Steel
Stand Pipe
Ground Surface
0' - 1 Grout
1' - 7' Bentonite'
1 _
7' - 49' Sand
AMW-2
•e •
•••�
• • • ►•'••
000•• lb• •••••
•ii 11•••••
•ii I••• •
•i i 0•••••
•i•i I••i ••
°ii ••• ••
•••• •0* •••
• • • 1 • • •
• �••• I•w•o•••
*•i•• 0� • •
•• ••IVO%
• • • II•••
•• ••• 0 •••••
••••• II •�•�•
• •• • •••�
•:
•••• 1ii •
• I•••••
•••
ii•
• • i P••
•_• • 1 •• i•i
•_•_•
49' Total Depth
4•c
2.5' kUp
9 Riser
9' - 49' Screen
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
Applied Resource
Management, P.C,
Hampetead, NC 28443
TITLE:
As -built for AMW-2
JOB:
10038
SCALE:
NTS
DATE:
5/04/ 17
DRAWN BY:
JLZ
FIGURE:

Print Forrr,
? L1 t O ISTRUCTION RECORD (CW-l)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name A
2. Well Construction Permit #: " try' -/- -
Li.vt all applicable well construction permits (i. e. UK., Canty, State, Yariat
3. Well Use (check well. use):,.
Water Supply Well:
Agricultural
pGeothermal (Heating/Cooling Su
Industnat/Commelal
rinjecjloo Well s
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Ideating/Cooling Return)
4. Date Well(s) Completed: 4/4/17
Sa. Well Location:
Invista
MunicipallPublic
Restdentlal+Water Supply (single)
ReAlentidt Water Supply(shared)
Groundwater Remediation
Salinity Barrier
f Stormwater Drainage
®Subsidence Control
'Tracer
Other (explain under #21 Remarks)
Well ID#AM W-1
N/A
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. (1)1N)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one pat/long is sufficient)
34 18 25.91
N 77 58 27.23 W
6. Is(are) the well(s)fx Permanent or JITemporary
7. Is this a repair to an existing well: QYes or ONo
If this is a repair,.1" out known well construction information and explain the nature afthe
repair ender 421 remarks .section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 55
For multiple wells list all depths if different (example- 3 rr.200' and 20100')
(ft.)
10. Static water level below top of casing: 13.66 (ft.)
If water level is above casing, use "—"
11. Borehole diameter: 6 ,,I p (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
Internal Use Onh
443591
14. WATER ZONES
FROM
10
DESCRIPTION
ft.
ft.
ft
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if apjlicable)
PROM
TO DIAMETER
THICKNESS
MATERIAL
0 ft
15 IL 2 'n•
SCH40
PVC
16. INNER CASING OR TUBING. (geothermal 'closed loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft
FROM
FROM
TO
DIAMETER'
.SLOT SIZE :
Iir
THICKNESS.::+
THICKNESS.
MATERIAT::2
15 -it-
55 m
2 in
010 . , -
SCH40 '
PUC - :',
ft
fL
iu:
:'
t SL.
XB.,CRo(kT'
r
n Lua'iF,a,-'v'J
PROM
TO
"MATERIAL
't
3MPIZI13EMENftm1CLHOD U*M i
0 . ` rt
,1 ft
Grout
n o!lfe
1 ft'
12 ft
Bentonde
`:Poured
ft
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METH OD
12 11
55 11•
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (atta
h additional sheets if necessarv)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc)
ft.
ft
See Attached
ft.
ft.
ft.
it.
fe.
flu
4 1,�, e t a I l i w4
ft.
ft
ft.
rt.
MAY 1 0 2017
ft.
ft.
'l7'^i4
21. REMARKS 111110f'ti'iC'.t4-if, r- 6,;T.y
OST1.,1/ti✓ ,
22. Certification:
Certified Wel
R
4/4/17
Date
By .signing t/ris/rum, I hereby Gerrit that the well(s) was (were) constructed in accordance
with GA NCAC 02C .0100 or ISA NCAC OK .0�( 2y0p0� Well Conslniction Standards and that a
copy ofthis record has been prowler th1ci 1 mil
/
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. YouWittesQgagimbliages if necessary.
0 etions Section
SUBMITTAL INSTR n Regional Office
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following_
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above. also submit one copy of this form within 30 days of completion of well
construction to the following.
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
here constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG •
INVISTA FACILITY
WILMINGTON, NORTH CAROLINA
AMW - 1 .1
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 4/4/17
/111-?:;,:rkt1;,;:cf/;:.
.-.' DEPT "
1T 5.,
(ir
DESCRIPTION
,(47,.a4;fltroW,:.
coNTENrcoilAtlilke:
4t.14a:inv.srgRVink
=',141?„11/4-1.•a414
gioBLOW
0 - 10
Tan to light brown, medium to coarse grained sands with root
matter/organics. No Hydrocarbon odor.
Low
MR
10 - 25
Tan -beige, fine to medium grained sand. No Hydrocarbon odor.
Moderate
to High
MR
25 - 40
Light brown to beige medium to coarse grained sand. No
Hydrocarbon odor.
High
MR
40 - 55
Light brown to beige, medium to gravelly sand mixture changing
to medium -dark gray, silty clay at 54'. No Hydrocarbon odor.
High
MR
MR - Mud Rotary
staittaW"'"WaSegfairtairr''
Tv,.);mutie‘<;ii

IMPIPIPMIS
♦ ► ♦•
♦ l ►
1' 13' Bentonitet♦ti ►♦�♦,
st
AMW-1
Lock
Protective Steel
Stand Pipe
Gr•un.l Surface
1
0' - 1'1 Grout
2.5' Stick Up
I♦♦fir ♦ ♦k
i ♦ • �DTW 13,66'I
12' - 55' Sand
•
r
1 ••••
iii. '• •••
r••.—•••
•_•_•_ r_•_• •
•4
1•••*04
• • .
!• •%
• •
•• .
• • • ••4
•_••
r•••
1• • •••
i• • •••
'••••
•••
I••••
•••••
r • • •
• •• •••.
•
r• •••
•
r
:
•
•-•-•
55' Total Depth
15' - 55' Screen
•
Note:
DTW = Depth to groundwater in feet
as measured on 4/18/17.
-.4%Nk
Applied Resource
Management, P. C.
Hampstead. NC 28443
TITLE:
As -built for AMW-1
JOB:
10038
SCALE:
NTS
DATE:
5/04/17
DRAWN BY:
JLZ
FIGURE:

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Info, motion:
Sanford Sweeting
Well Contractor Name
2082-A
NC Well Contractor Cmri 6cation Number
Applied Resource Management, P.C.
N/A
2. Well Construction Permit #:
List al! applicable well constterctlon permits (Le. WC, County, ty, State. Variance.
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
1Monitoring
on-Water Supply Well:
QMunicipal/Public
DResidential Water Supply (single)
Residential Water Supply (shared)
njection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothemml (Closed Loop)
Geothermal (Heating/Cooling Rehm)
4. Date Well(s) Completed: 3/22/17
5a. Well Location:
Recovery
Groundwater Remediation
QSalinity Barrier
DStormwater Drainage
Subsidence Control
Tracer
'Other (explain under #21 Remarks)
Well ID# N/A
Dr. W. Nixon, Jr. N/A
Facility/Owner Name Facility 1DN (if applicable)
1946 S. Live Oak Parkway, Wilmington, NC
Physical Address, City, and Zip
New Hanover
R0600-8009-005-000
County Parcel Identification No.(N)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/tong is sufficient)
34 14 24.8719 N 77 54 16.4135
6. Is(are) the well(s)I'.Permanent or QlTemporary
7. Is this a repair to an existing well: QYes or QNo
If this is a repair, ill out known well construction it fm-rnalion and explain the native of the
repair under P21 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 185 (ft.)
For multiple wells list all depths ifdferent (example- 3@200' and 20100')
10. Static water level below top of casing: 28
Ifwater level is above casing, use "-"
11. Borehole diameter: 5 7/8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable. direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 25
Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10 Gallons
For Internal Use Only:
1 3
90
14. WATER ZONES
FROM
TO
DESCRIPTION
Ft.
ft.
R.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap t cable)
FROM
TO
DIAMEI ER THICKNESS
MATERIAL
0 ft
155 ft.
4 in. SCH40
PVC
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
NI.ATERL4L
ft.
ft.
in.
f
fr.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
155 ft
185 f'-
2 in.
.010
SCH40
PVC
ft.
ft
n.
18. GROUT
FROM
TO l MATERIAL
EMPLACEMENT METHOD &AMOUNT
0 ft.
155 f°
Bentonite
Poured
ft.
11.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
155 ft
185 ft
# 2 Silica
Poured
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if necessan-)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 It
15 fA
Sand
15 IL
30 ft
Sandy day
30 ft.
45 ft
Gray clay
45 it
55 ft.
Clay with layered limestone
55 It
90 ft
White limestone
90 ft'
145- ft.
Clay sand and layers limestone
145 ft
185 ft•
Sandstone layers of sand
21. REMARKS
22.t 'tication:
/DWR
ofCerufied ' ell ontracto
LJ i� i'7
Date
By sigmng this form, / hereby cezllljf'ilrat (,,:ere) constructed in accordance
with ISA NC'AC 02C .0100 or I5A NCAC cn ds and /hata
copy of this record has been provided to theyp t. ' C a�
23. Site diagram or addihWa eg C ddd���zzr
You may use the back W1 ,pi tj6'dl cealaflf ite details or well
constmetion details. You ma 1. 8laeeees if necessary.
SUBMITTAL INSTRUCTIONS 'y'}jEAf{ (IC,drl Process4ng Bra
1't, V4"GUSGia
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:'
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
constmetion to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply Sr Infection Wells: In addition to sending the forvn to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID Cif applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection 0
Irrigationd Other 0 (list use)
DATE DRILLED 07/18/12
4. WELL LOCATION:
200 Snua Harbour Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton cowry New Han.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley ❑Flat DRidge DOther
LATITUDE 34 " DMS OR DD
LONGITUDE 77 " DMS OR DD
Latitude/longitude source: 3PS [Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
3caj
Facility Name Facility ID# (if applicable)
Street Address
City or Town
Kevin O'Brien
Contact Name
200 Snua Harbour Dr
State Zip Code
Mailing Address
Wilmington NC 28405
City or Town State Zip Code
(910 ) 262-1961
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 145'
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: 25'
(Use "+" if Above Top of Casing)
NOW
FT.
2412-A
4 f P'� ..
' ' c3i
d. TOP OF CASING IS 1 .5' FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST Airlift
f. DISINFECTION: Type HTH Amount 3 uT 10%
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +1.5' Bottom 130' Ft. 4" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0' Bottom 22' Ft. Grout
Top Bottom
Top Bottom
Ft.
Ft.
9. SCREEN: Depth Diameter
Top 130' Bottom 145' Ft. 4"
Top Bottom Ft.
Top Bottom Ft.
10. SANDIGRAVEL PACK:
Depth
Top 125' Bottom 145'
in.
in.
in.
Method
Tremmie
Slot Size Material
.020 in. PVC
in.
in.
Size Material
Ft. #2 Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0' / 52'
Formation Description
Clay / sand
52' / 90' Limestone
90' / 130' Clay
130' / 145'
12. REMARKS:
Sallt4tivtAt trEkAiiii
/ t
/ Water QdaliWRegionaLLs`»'
/ ngtRegfona Operations Section
Of)fc wum on e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
CORD HAS O(VDT THE WELL OWNER.
07/18/12
SIGNATURE OF CERTIFIED WELL CMTRACTOR DATE
Donald H Cumminas
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form CW-lb
Rev. 2/09

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 4146A
1. WELL CONTRACTOR:
D.T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) HMW-1
3. WELL USE (Check One Box): Monitoring IXI Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 111 Injection ❑
Irrigation ❑ Other ❑ (list use) -
DATE DRILLED: April 27, 2012
4. WELL LOCATION:
1 Hanover St., 28401
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WllminatOn COUNTY: New Hanover
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley ®Flat El Ridge ❑Other:
LATITUDE- 34.244012025 DD
LONGITUDE: 77.950276479 DD
Latitude/longitude source: ® GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.) �e-q
5. FACILITY (Name of the business where the well is located.)
The City Marina Wilmington, LLC N/A
Facility Name Facility ID # (if applicable)
1 Hanover St.
Street Address
Wilmington
City or Town
Kyle Myers
Contact Name
720 N 3rd St.
NC
State
28401
Zip Code
Mailing Address
Wilmington NC
City or Town State
(9101- 251-6160
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 15
28401
Zip Code
b. DOES WELL REPLACE. EXISTING WELL? YES ❑ NO [XI
c. WATER LEVEL Below Top of Casing 9.8 FT.
(Use "+" if Above Top of Casing)
tw7
d. TOP OF CASING IS 3.16 FT Above Land Surface*
• Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): WA METHOD OF TEST: WA
f. DISINFECTION: Type WA Amount: N/A
g. WATER ZONES (depth):
Top
Top
Top
Bottom
Bottom
Bottom
Top
Top
Top
Bottom
Bottom
Bottom
7. CASING: Thickness/
Depth Diameter Weight Material
Top 0 Bottom 5 Ft. 2 in. Sch. 40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Top
Top 1
Top
9. SCREEN: Depth Diameter Slot Size
Top 5 Bottom 15 Ft. 2 in. Slot .010 in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 3 Bottom 15 Ft. #2 Medium Torpedo Sand
Material Method
Ft.
3 Ft. Bent. Pellets Surface Pour
Ft.
Material
PVC
Top
Top
Depth
Bottom
Bottom
Bottom
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
R�CDENRIDWR
Formation Description
IN G
-.5 SEE
/tsey �0HATTACHED
12. R�lRni3_ rZ0;
t/I2
, rma
TM/nlH�r1rsstn2 i lni•i;.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OF CERTIFIED WELL C�JI `TRACTOR
.T. Chalmers, Jr.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality /.
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
VINCE FEDERLE
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE
City or Town
(704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 28625
State Zip Code
OTHER ASSOCIATED PERMIT#Qr applicable)
SITE WELL ID #(if applicable) MW-14
3. WELL USE (Check One Box) Monitoring 1 Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 07/10/12
4. WELL LOCATION:
2375 SOUTH 17TH STREET 28403
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WILMINGTON COUNTY NEW HANOVER
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley itlat ❑Ridge ❑Other
LATITUDE 34 ° 11 ' 59.1900 " DMS OR DD
LONGITUDE 77 ° 55 17.3800 " DMS OR DD
Latitude/longitude source: WPS [topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)``•��
5. FACILITY (Name of the business where the well is located.)"` 7
PANTRY - 464
N/A
Facility Name Facility ID# (if applicable)
2375 SOUTH 17TH STREET
Street Address
WILMINGTON
City or Town
THE PANTRY INC
NC 28403
State Zip Code
Contact Name
305 GREGSON DRIVE
Mailing Address
CARY
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20.0 FEET
b. DOES WELL REPLACE EXISTING WELL?
NC 27511
State Zip Code
YES ❑ NO [N%
c. WATER LEVEL Below Top of Casing: 11.0
(Use "+" if Above Top of Casing)
FT.
3552
d. TOP OF CASING IS 0.0 FT. Above Land Surface`
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top 0.0 Bottom 5.0 Ft. 2 INCH SCH 40
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0.0 Bottom 3.0
Top Bottom
Top Bottom
9. SCREEN: Depth
Material
Ft. PORTLAND BENTONITE
Ft.
Ft.
Material
PVC
Method
SLURRY
Diameter Slot Size Material
Top 5.0 - Bottom 20.0 Ft. 2.0 in. .010 in. PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 4.0 Bottom 20.0 Ft. 20-40
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
FINE SILICA SAND
Formation Description
0.0 / 1.0 TOPSOIL
1.0 / 5.0 TAN SAND
5.0 / 10.0 . GRAY SAND
10.0 i 2otECEIVED/N AND•
MAY 2017
/ tv.r.. ')
/ fl cn
Water Quality Regional't0rrnar .07i
Operations Section
Wilmington f'oc`" !/;
12. REMARKS:
BENTONITE SEAL FROM 3 0 TO 4.0 FEET
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N AC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
EC . D HAS BEEN PROV}D TO TWELL OWNER.
L.?-_K�J�/,FAj �#�/\ P.7_7S!/On F/S/G-- 07/27/12
SIGNATURE OF CERTIFIED WELL 'CONTRACTOR DATE
VINCE FEDERLE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form GW-lb
YtY - 9, Rev. 2/09
1617 Mall Service Center, Raleigh, NC 27699-161, Phone [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD C_ 0 n ?
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3552
1. WELL CONTRACTOR:
VINCE FEDERLE
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE
City or Town
L704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 28625
State Zip Code
OTHER ASSOCIATED PERMIT#(k applicable)
SITE WELL ID #(if applicable) MW-15
3. WELL USE (Check One Box) Monitoring FV' Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 07/10/12
4. WELL LOCATION:
2375 SOUTH 17TH STREET 28403
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WILMINGTON COUNTY NEW HANOVER
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope ❑Valley otlat ❑Ridge ❑Other
LATITUDE 34 ° 11 ' 59.1000 " DMS OR DD
LONGITUDE 77 ° 55 19.1600 " DMS OR DD
Latitude/longitude source: 3PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) '7 7 05. FACILITY (Name of the business where the well is located.) 3
PANTRY - 464 N/A
Facility Name Facility ID# (if applicable)
2375 SOUTH 17TH STREET
Street Address
WILMINGTON NC 28403
City or Town State Zip Code
THE PANTRY. INC
Contact Name
305 GREGSON DRIVE
Mailing Address
CARY
City or Town
NC 27511
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
c. WATER LEVEL Below Top of Casing: 11.0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0.0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top . Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 5.0 Ft. 2INCH SCH4o PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0.0 Bottom 3.0 Ft, PORTLAND BENTONITE
Top Bottom Ft.
Top Bottom Ft.
Method
SLURRY
9. SCREEN: Depth Diameter Slot Size Material
Top 5.0 Bottom 20.0 Ft. 2.0 - in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 4.0 Bottom 20.0 Ft. 20-40 FINE SILICA SAND
Top Bottom Ft.
Top Bottom Ft.
711. DRILLING LOG
Top Bottom
0.0 / 1.0
1.0 / 5.0
5.0 / 10.0
10.0 / 20.0
Formation Description
ASPHALT/GRAVEL
TAN SAND
GRAY SAND
DARK GRAY SAND
/ 'i .,. CEIVED/NCDENR/DWR
tg"�
/
sv.Y �-�iP1MAY i 5 2017 t �r
Water Quality R4`mnn�J1 & %nr�
12. REMARKS: Operat1005 Section tron ,oro rc
BENTONITE SEAL FR �i gt9%l� ��el OffiC 'VQ,,�=ss/;w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N AC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
E D HAS BEEN PRO D TO T. WELL//OWNER.
intC/trai. f3r2n�� 07/27/12
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
VINCE FEDERLE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 clays of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1b
Rev. 2/09

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Sanford Sweeting
Well Contractor Name
2082-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
N/A
List all applicable ire!( eonstrction permits (i.e
3. Well Use (check well use):
'IC, Conran State. 4 ariance. etc)
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
X !irrigation
Non -Water Supply Well:
Monitoring
DMunicipaVPublic
DResidential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
DExperimental Technology
/Geothermal (Closed Loop)
!Geothermal (Heating/Cooling Retum)
4. Date Wen(s) Completed:4/3/17
DGroundwater Remediation
DSalinity Barrier
DStonmwater Drainage
DSubsidence Control
DTracer
DOther (explain under #21 Remarks)
Well ID# N/A
5a. Well Location:
Monteith Construction Corp. N/A
Facility/Owner Name Facility IDA (if applicable)
1890 Trask Drive, Wilmington, NC
Physical Address, City, and Zip
New Hanover County R04200-001-025-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
34 18 25.95 N 77 54 41.509
W
6. Is(are) the well(s)0Permanent or DTemporary
7. Is this a repair to an existing well: DYes or EINo
Ithis is a repain,fill out known well construction information and explain the nature ofthe
repair under :31 remarks section or on the hack of this foray.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:!
9. Total well depth below land surface: 60
For multiple wells list all depths ifdifferent (example- 3@200' and 2@100')
(ft.)
10. Static water level below top of casing: 6 (ft.)
!/water level is above casing, use •'-"
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: Mud Rotary
(Le. auger. rotay, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gym) 50 Method of test: Airlift
HTH 0
13b. Disinfection type: Amount: 3 /o@10g
For Internal Use Only:
l Print Form
443075
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft
15. OUTER CASING (for multi -cased wells) OR LINER .(if ap .licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
40 ft.
4 in.
SCH40
PVC
16. INNER
CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
ft.
ft.
in.
17. SCREEN
MATERIAL
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
40 ft
60 it.
4 "`
.020
SCH40
PVC
ft
fe.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft•
45 ft
Bentonite
Poured
ft.
It.
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable).
FROM
TO
MATERIAL
EMPLACEMENT METHOD
45 ft
60 ft.
#2
Poured
ft.
ft.
20. DRILLING LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION Icalor. hardness, soil/rock type. grain size, etc.)
0 ft.
10 ft
Sandy silt
10 D-
25 It
Sand with shells and clay
25 ft•
35 ft
Clayey sand
35 ft
60 ft
Coarse sand
It
ft
N -.'s. 1 .
ft.
ft.
� B
ft
APR 1 7 2011
21. REMARKS -.
nniC2rwwtliln Prooass+ng 1.1n4t
04'4L,i1t3(f,
Tgnature/fCenifieTWell Contractor Date
By signing this _form, 7 hereby eery' that the weeks) was (irere) constricted in accordance
with 15A NC e 02(• .0100 or .15A NCA(' 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following: p pp/�Q p�p�fl wp
Division of Water ReRs E4cEe�utdi`dPt5t4�2i11rP1td6ls'sRsg Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617 •
24b. For Iniection Wells: In additi*ipRe2cli4g term to -the address in 24a
above, also submit one copy of this form within days of completion of well
construction to the following: yyLL��
Division of Water Resources,•L'!p gd bail control Program,
1636 Mail Sen•ice,l mIIngton gionalOffice
636
24c. Fgr Water Sunnly & Iniection Wells: In addition to sending the fort to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fenn GW-I
North Carolina Deparnnent of Environmental Quality -Division of Water Resources Revised 2-22-2016

ARM Project Number: 107 Fox Lane Airtech Mechanical Pagel
Hubert, NC 28539
Driller: John Salmon
Date Drilled: Loop No. Loop Depth GPS Coordinates
3/13/2017 1 255 34 38 45.4263 77 11 12.8914
3/14/2017 2 255 34 38 45.4477 77 11 13.2811
3/14/2017 3 255 34 38 45.7537 77 11 13.2814
3/15/2017 4 255 34 38 45.4477 77 11 13.2814
RECEIVED/NCDENR/DWR
APR 2 4 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Sanford Sweeting
Well Contractor Name
2082-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well cousmvctron permits 0.e. (AC, Conn
3. Well Use (check well use):
N/A
i/ate. I'',Mattce. etc.)
Water Supply Well:
DAgricultural
Geothermal (Heating/Cooling Supply)
lndustriaVCommercial
X Irrigation
Non -Water Supply Well:
DMonitoring
Injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
1Geothemial (Heating/Cooling Return)
4. Date Well(s) Completed: 3/29/17
5a. Well Location:
Municipal/ Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
DGroundwater Remediation
DSalinity Barrier
QStormwater Drainage
Q'Subsidence Control
QTmcer
)Other (explain under #21 Remarks)
. Well ID# N/A
John and Mary Clark N/A
Facility/Owner Name
8 Cedar Island
Facility ID# (if applicable)
Physical Address, City, and Zip
New Hanover
R06700-003-003-009
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if Well field, one lathong is sufficient)
34 11 11.4074 N 77 50 6.0145
6. Is(are) the well(s)JX'Permanent or QTemporary
7. Is this a repair to an existing well: DYes or [ago
If this is a repair,,fill out sworn well construction information and explain the nature of the
repair under 21 remarks section or an the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 180
For multiple wells list all depths if different (example- 3@200' and 20J100')
(ft.)
10. Static water level below top of casing: 10 (ft.)
If water level is above casing, use "-
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger. rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gum) 00 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% 10 Gallons
For Internal Use Only:
443074
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
ft.
15. O1:TER CASING (for multi -cased wells) OR LINER ('f ap icae lbl )
FROM
TO
DIAMETER
THICKNESS MATERIAL
0
f.
160 ft•
4
in.
SCH40 PVC
16. INNER CASING OR T TBING (geothermal closed -loop)
FROM
ID
DIAMETER
TRIMNESS
MATERIAL
ft.
ft
in.
ft.
17. SCREEN
in.
FROM
160 rt
TO
180
DIAMETER
4
SLOT SIZE
.020
THICKNESS
SCH40
MATERIAL
PVC
ft.
18. GROUT
FROM
0 ft.
TO
155 ft.
MATERIAL
Bentonite
EMPLACEMENT METI OD & AMOUNT
Poured
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
155 ft
180 rt•
# 2 Silica
Poured
ft.
ft.
20. DRILL]NG LOG (attach additional sheets if nece
FROM
0
TO
30 ft.
)
DESCRIPTION (color., hardness, soiVrock ape, min size, etc.)
Sand some silt
30 R.
60 n.
Sand and shells
60 ft.
130 fe.
Limestone
130 ft.
150 ft.
Silty clay some sand
150 ft
180 ft
Sandstone
ft.
D.
21. REMARKS
APR 1 7 2017
22. Certippcat•
vl..
n:
As-
ed Well Contractor
to wl.
DV
Drat- n.0011 Ue'k
BOG
3-y7-/1
Date
By signing this form, 1 hereby cenijy that the weeks) was (were) constructed in accordance
with 154 NCAC' 02C.0100 or 15A WAG 02C .0200 Well Canstneceion Standards and that a
copy Al this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
246. For Injection Wells: In the address in 24a
above, also submit one copy 5. ' .1) i 11t i.'; ompletion of well
construction to the following:
Division of Water Resources, UJ(t[glgrgji>y(l Injection Control Program,
1636 Mail Service Cafet; Rlllet h ce(27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the addresses) above, also salilttat@LaNi6;tyoRegiolgen within 30 days of
completion of well construction t®pw'ationp Selitjodepartment of the county
where constructed. Wilmington Regional Office
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit k:
List all applicable well cantO'ncllea pennitr Ire (TIC', ("au
3. Well Use (check well use):
N/A
Sao run
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
[Industrial/Commercial
D']rrigation
Non -Water Supply Well:
'M
onitoring
Well:
❑MunicipaldPuhlic
Residential Water Supple (single)
DResidential Water Supply (shared)
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
xperimental Technology
eothennal (Closed Loop)
eothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 3/22/17
5a. Well Location:
Herbie Hub, LLC
Facility/Owner Name
812 4th Street N,
Physical Address; City, and Zip
New Hanover
DRecoveiq
DGroundwater Remediation
DSalinity Barrier
DStonnwater Drainage
D:Subsidence Control
DTracer
DrOther (explain under d21 Remarks)
Well ID#TW 1
N/A
Facility IDn (if applicable)
Wilmington, NC 28401
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient}
R04813-002-009-000
34 14 42.31 N 77 56 42.84
W
6. Is(are) the wells) xPermanent or DTemporary
7. Is this a repair to an existing well:. Dyes or DNo
if this is a npab, fill out knit} well construction Woe/nation and explain the natm'e of Use
repair under.=21 remarks section or on the hack grthis form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:l
9. Total well depth below land surface: 22
Far multiple wells lint all depths Ifdiferent (example- 31td200' and 20100')
10. Static water level below top of casing: 15.03
Ifeater level is above casing. use "-"
9"
11. Borehole diameter: (in.)
12. Well construction method:
(i.e. auger. rotary, cable. direct push. etc.)
For Internal Use Only:
14. WATER ZONES
DESCRIPTION
15. OUTER CASING (for multi -cased wells) OR LINER (if a n livable
FROM 10 DIAMETER a�sr
THICKNESS
SCH40
16. INNER CASING OR TUBING : eothermal closed-loo
FROM To DIAMETER
red
TO DIAMETER SLOT SIZE THICKNESS
L 22 rL 2 .010 SCH40
18. GROUT
h1ATERL41.
5 It. Bentonite
MATERIAL
Coarse
THICKNESS
EMPLACEMENT OD AMOUNT
Poured
EMPLACEMENT METHOD
Poured
20. DRILLING LOG (attach additional sheets if necessar
FROM TO DESCRIPTION Rotor, aAl'l1afS5. s"irmflp Cp1:1i05ii¢ flf.)
rt. See Attached
22. Certification:
W:02e r Quality Regonal
Signs ure ofCerlifred Pell Contractor Wlin' 0'i"inn artateHr signing this Tarn, 1 hereby cenneTh that the ell4) ryas (amy) corm/racier in accord n ce
eitTh 1SA MY'AC 02C .0100 or ISA .Nt A(' ll2(.00 0'e1! Comtrucaion Smmim t mar thal a
copy of this record has been provided to the wall mnrer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
constnletion 10 the following:
(ft.) Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
Auger 24b. For Infection Webs: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A N/A
Method of test:
13b. Disinfection type: N/A N/A
Amount:
Form GW-1
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & In'e N Wells:
form to
the address(es) above, also submit one copy of thisen
additr form on toswithin di30 days of
completion of well construction to the county health department of the county
where constructed.
North Caroline Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016
Form

TW-1
Lock
Ground Surface
ENINS
IIIMNEININ Mae
4.5' Bentonite v .®
MINNEERI
NSW 'MINNIE'
rsa-
r•••ENNINIMIE MEMO
eta '`•�•••
� ••• ••' '• • • •
i
r•••••i 0• ••••
►•••••• •••e•• •
,
i• ••••: I• ••••(
r•• • r+•••••
•••••• •®• •
•••••• _ s•�•••
••�••:• •••••+
®••• • • • 4
►•••moo® +•• • •
Groundwater • • • • - ,•••••`
Table ••• • . -. i�•••i
L%1.:._-.:<c
•••;--- •••
17' Sand ► • • ._- r• • ••
►`•tee * ••%• • +
►•• • •----. e••••®
®••••i- ••••••+
•••-r•••
••• •• •I !••••®•'
►•••;•4_ • ••• i
►•a•••i- `•••••
• • • )®•••••
®••s•i•r :•• •
•' -1
• • ••••• IP•• •'
,left• •_•_•_•_•
7' Riser
15' Screen
Y 22' Total Depth
TITLE:
App!ie Resource ounce Type ll Monitoring Well As -Built
Management, l'.0 JOB: ;SCALE
-am�E�Qa,ticza�a ��„ DATE:DRAWN:BY:
17049 Not to scale 4/5/17 KLC
WELL ID:
TW-1

BORING LOG
HERBIE HUB, LLC PROPERTY
812 4T" STREET N
WILMINGTON, NORTH CAROLINA 28401
Drilled by: Applied. Resource Management
Logged by: J. Zuncich
Date: 3/22/17
Description
Medium to dark gray, very fine to fine sand with debris, concrete, and
brick. No hydrocarbon odor.
Tan brown very fine to fine sands. No hydrocarbon odor.
Medium brown, fine to medium grained sand. No hydrocarbon odor.
Light brown, gray fine to medium grained sand, No hydrocarbon odor.
Light brown, gray fine to medium grained sand, No hydrocarbon odor.
Medium
Medium

BORING LOG
HERBIE HUB, LLC PROPERTY
812 4T i STREET N
WILMINGTON, NORTH CAROLINA 28401
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 3/22/17
Water
Content
Medium to dark gray, very fine to fine sand with debris, concrete, and
brick. No hydrocarbon odor.
Tan brown very fine to fine sands changing to orange clayey sand from
7' to 8'. No hydrocarbon odor.
Medium brown, fine to medium grained sand. No hydrocarbon odor.

BORING LOG
HERBIE HUB, LLC PROPERTY
WILMINGTON, NORTH CAROLINA 28401
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 3/22/17
Water
Content
Low
White to beige fine sand. No hydrocarbon odor.
Low
10 - 12 Orange, fine to medium grained sand. No hydrocarbon odor. -
Ila
Medium to dark gray sand with debris, brick and concrete. No
hydrocarbon odor.
Brown/gray fine to medium grained sand. No hydrocarbon odor.

WELL CONSTR(LCTION RECORD (GW-1)
1..WWell contra iotbrmatien:
wen Co Nerve
a -AS
NC WAD Ceoeracew terdtkadan Number
dQ tk.ea`/B ,wra.lj
Company Name
2. Weil Comtruotioa Permit a:
Lin allapparehlo wag cetatnadMnprntits de. UIC. Oam 3ie VerlwncA mej
S. Well Use (deck well use):
Water Supply Well:
'cultuhal
Gemhennd (Ileal(ng/Cooling Supply)
Industrial/Commercial
'adieu
Non -Water Supply Wen:
Monitoring
Injection Welt:
IAquifbrRedtarge
Vsquilts Storage end Recovery
Aquifer Test
Expertmentel tedimology
Geothemml (Closed Loop)
IFor bfernel Use Only:
14. WA'
ego
coo
44259,E
24
39
tL R.
15'OUtERCASING trot
Ca Ar$ S4.04
PROM TO D4MMR _ WLINUUkURdrmWiet6le)'
'ri d :1.0h a. ILi5wk..y6
:: SINNER
7D mLNt'[aR 1 Want -) tMramw4
fL
ft. in,
AIZRAV
dQ..
ft. l R.
°Municipal/Public
faesidertis Water Supply (single)
[]Residential wader Supply (shared)
DRUCOMY
OGroundwatturRemedimion
©Salinity Battier
f Stomewater Drainage
©Subsidence Contol
l 1Goodwood (Heating/Cooling Rolm) . i'� (explain under021 Remarks)
4. Date Wd1(s) Completed: as -3�-vh , Well Wit •
Se. Well Loudon: -
C�AlAl:4 APO.. -Cc
Paeteq/DaaerName Facility Did (ifspplimble)
5i
Physical Addmss, Coy, and Zip
Nate ALA- Vac -
County Panel Mmadrahim No, (PIN)
5b. Latitude ad longitude in degreeyminunNaecawfe or decimal degrees.
Orwell field, on Wag is md'wieap
42: I.MA d e. a lt001
34° /3,n P4 o"I° S. F69. w
6. h(are) De well(s)ti,Permanent or QTempornry
7. Is ON repair toaoetie6ag walk QYes or C`a
tfthts kerepmv fUm akoorn wog onst vafon Otrorm r(onaadeaplan Ma ware Ohs
repair weir x21 remarke.etif= or on the Dock q/0a fora.
8. Far Geoprobe/W T or Closed -Comp Geothermal Wells having the ssnm
e:pmattUatten, only 1 GW-1 is nada Indicate TOTAL NUMBER Of wells
drilled:
9. Total wall depth below Ingd eurfaee: 3 S (pt.)
Formultiple well( lire all*Ole 17dfrent (emmpfa 363200' and2(3100)
10. Stage water level below top of easing:
"Wet fowl LraMre WOW urm "+^
11. Borehole diameter: 4
12. Wen anebuetion method: 'Ste'
(La auger, rotary,mbte, direct pub, coo.)
(kL)
/3
(n)
FOR WATER SUPPLY WELLS ONLY:
13a. Tien Men) /S' Method of test: rin-,
13b. Div&Dtedoe type- Amount:
37
PROM I TO
a.o R 1 3r
eRo To
0
R.
fL
et.
R
D/AMEITS
V
la
Saar
0 f0
'rmxswrgt
SeSrnU
MIPrACaemNr
JWAL
OD &
Phut - tic^
C
UNT
�l h.
19. YEL'PACIClifiPdfeDlel .•L
most TD
R I It.
MA
e aasixfl&Wmo
.fo7DRalt.tt atape
PROM
D.
To
a
OISmurnrMan Wee. wawa ben Realm elm)
it.
h
ft.
ft.
D.
iL
R
WRD*L4RRt..
rt.
R.
a
RECEIVED
LIAR 2-5 2017
•,,ss+n9 Un
Swann ofCatieed{ II meaner Dais
By Apse this& be oy mnfr (hat the watff) vat f eonamted m ccmnamee
oath 15A *wce C 0(00 or ISA NCACO2L' .0200 Weil Conaffirctioo :taodnt*ardxm a
copyq(th(arecord kat been prooidedlathe wort oar.
23. Site diagram or additional wall deans:
You nay use the hack of this page to providt additional wee site details or well
commission details. You may also attachaddidonai pages if necessary,.
SUBMITTAL INSTRUCTIONS
24a. For A11 W - s: Submit this form within 30 days of completion of well
consmiefon to the following:
Dksidoa of Water EiNourcea. leonuation Preemehng Colt,
1617 Mall Service Center, Raleigh, NC 27699-1619
24b. for !election Well: bi addition to sending the Conn to the address in 24a
above, also submit one copy of this form withio 30 days of completion of well
wnstmctlon to the following:
Division of Water Resounds. Underground lmjecden Control Program,
1636 Mae Smviee Cuter, Raleigh, NC 276994636
24e. pot ater Snooks & iniecdeu Wdl1: In addition to sending the form to
We addresses) above, also submit one co1p( v 3 or
completion of well construction to the earn.. H t V ty
lwlarn rnnan rM
APR 0 3 2017
Water Quality Regional
ODeratinnc carting

WELL CONSTRUCTION RECORD (GW-11
1. WM Contractor Information
G,s apes
Wen Oontr6gwName
211s1
NC Well Contractor Cerlideadan Number
Zia..A a sl ctl '. i2tlr Il, s.
Company Namo
2, Well Construction Permit #:
Lixl an applicable wall eoadnMMn penmen Oh UIC. CAS Sma, Penman¢¢• ad.)
3, Wen Use (check well rate):
Water Supply Well:
]Agricola¢.
�oeothertnal Mating/Cooling Supply)
Industrial/Commercial
For internal Use Only:
442591
•14trA7mRzoNES .+'.'!:`;'••l• ,
ASICMIPTION
•QM TD
aa„p a. 3r
(b 0
e °JltS'
at aura C4SEMIhr:Di' astental.R'.EIRRE faapatebiet:•.
raaM_
Woman {TWCNNeSS MATlma
.�) ft 0 f6 a hu ISn.1o4A eJeL.
r:Mtit BB' OR } . ,.
PROM mAMTMCipaASB MATERIAL
B. 0. in.
h R in.
°MlnaicipaVPubile
f Roswendal Wet& Supply (singie)
©Residential Water Supply (Mated)
.17MOIRBN " ,
Non -Water sapply Wdl:
Monitoring
ojaedaa Well:
Aquifer*eeharge
Aquifer Stomp and Recovery
Aquifer Test
Experimental Technology
(Bahama! (Closed Loop)
Geothemid (Wearinp/Cooling Return)
°Recovery
❑Cmwndwater Remediatioc
©Salinity Barrier
°smtmwata Drainage
°Subsidence Coodol
°Tracer
("Other (apinln under #2l Ramadls)
4.Date Well(a)Complexd:2.^'/-j'i Well IDS
• Sr. Wen London:
pcy w 1.1 Rine so-
FxlSry/Owner Name Facing rp#(ifapplmble)
aai GroA,L 'I NC
Physical Andrea, City, and Zip
J44 2 tlte.»Je..-
ConnU' Paroei Identiliration No. (PIN)
5b. ladtude and longitude in degrem/minuts/seeends or decimal degrees:
(irweu Said. one Wane iasansieng
DX Lai j,at
3Wu /6a003 N o73p yg, OP?' w
6. ($.re) the wcll($ ermanent or ©Temporary
7. is this a repair to s existing welb °Yes or ONo
VW, is repair, Jill aNbnlwn wellaannNMkm lnfannatlan endexplcln the nanny erne
Papal. mat ft2l sum* nuke uran Me bock nfthiefe nn.
S.For G.ep uWD.PTorClase oo Geothermal Wellshaving the same
construction, only 1 GW-I is needed. Bete TOTAL NUMBER of wets
dlllkd:
S. Total well depth below land eartacer 3 t (1.)
irormnalpre wwipi*tdt depths'diffeuent /ammple• 3(r0200'and 2(g1I00)
10. Stade water level below top of cadet, ©i
Winter level lx°have LDeb{e Wen "+"
11. Ilarehole diameter: la, On.)
12. Well coasenicdoe method: "
(Le. amen relay, cebk. d'eeei mob. etc.)
(f )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) J S Method °facet:
VJMr
13b. Disiafcetos type: Amount:
0 0 I .i$ 0Mil 70 1 Diatra ell (norms
' I ), it Otto
rd
It,
in.
TRMIO1168 mourn e
ScA4( f1ug
yaw to mormum, Gr-0Q;Nf tea19OD A AMOUNT
a'O i `'4p, !?r.f rant
0 1e
0.
R.
.a9JSjOYDMIONED
TO
ie.
D:
D.
0.
•0ar'OROT+m9D'.YOraim
PROM To
R
a.
a.
1. ,, £MPRACLMCNr MEWODu,••.
arejvaiq ¢lent
R.
a.
ro
rt.
tC
R
a.
h
re
0.
FECEIVEC.
8 2017
iMWMaltiOrt Processing Unit
CiWi-0rrsua
Strome upn.ra.e �� ~
Date
Sy so Ihil form. I hwebj(4,ulej• Its the WIN was (ware) eanstacted in accordanee
wino ISA NOW 02C.0100en IM NOW mt:.0200 Well Ce mmnOae amadardt an a
eopy4P'dlamod has been pnaadedt. the weeowaar.
23. Site diagram ar additional well details:
You now use the back etas page to provide additional well site details or well
construction semis. You may also abaehaddltiond pages ifnmessmy,
SUBMITTAL n4fTRUCTIONs
24a. For MI Wdb: Submit this from within 30 days of completion of well
cowman to the rollout
Divwton of Water Reaoarm. mtbrma6at Processing Unit,
1617 Men Service Center, BatelgaleC 27699-1617
340. For Mitchell Wens: In addition to sending the form to the addicts in 24a
above, also submit lone copy of this }lour within 30 days of completion of well
construction to the following;
Mahlon ot Water Resoarees, Uadergroaed Inieetlon Cones Program,
1636 Mail Sepia Center, Rakigh, NC 27699.1636
2 e. For Water Supply & Inkedao WAR In ir, PM SgqqP
die addrces(a) above, also submit one copy o is ibfeE
completion of well construction h the county bealth depaonac or the cowity
WNW Anneimmad
x/I1
APR 0 3 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-I1
1. Well Canffactor Information:
IFor Internal USe.Only:
4.42590
NO Commadr Name
Ae49
NC WWI Connector Calffea6on Number
'Company Name
2. Well Construction Permit#:
lift all oppllmseweft rn 4lon pmrmilr fie, (liC Cowry, &me. banana, eft/
3. Well Use (check well use):
Water Supply Well:
Q.9gricultural
°Geother al(FfaasiagCoolmgSupply)
flimflam
Nos-Water Supply Well:
RMonitoring
eettoa Well:
3AquiftrRecbarge
©Aquikr Stooge and Recovery
©Aquila Tint
nE ptrimental Tcehnobgy
DGeotkamei (Closed Loop)
-.a
rGWthenial (FleadnA/Cooling Rehurr)
®Mw 1pipal/Public
QResidcndal Wafer Supply Ogle)
QResidential Water Supply (shared)
DReftWery
QGroondwaler ltemediation
Q'Stdinity Barden
°Stermwata Drainage
QSubsidence Control
Mu"
Gotha (explain under el Remake)
4. Date Wall#) Completed: 3- • /7 Well DM
• Sa. Wen Loudon:
.SL►4.Cryits,dcS 'ate
rannpw...:
' raeui.y Junta applicable)
"W1 Q\AMpleads) UA W,),in N(t
ebystal Adtress. City. and bp
Nae3 #4"tw
COW* real ldeunaaeWn No. (PIN)
SO. Ladtad( and'bpglmde in depzes/mbau$Sseeoudsor decimal degrees:
(await fre)d, one !oolong is sufficing
34° OS.kda N
07r)° s-y, ys'3 w
6. !gate the weg(s)OPermaneot Or ®Temporary
7. 1s this s repair to en existing well: ©Yes or Owe
obis 4 arepof•,Nl awkrawn well conswlfao Wfoni'cfiorcod erplo4 the mate ofyhe
waft carder all romate,nation or on du aarkVIAL /6wn.
S. For Geoprobedffir or Cfined.Loop Geothermal Welk having die same
emanation only 1 GW4 is needed. indicate TOTAL NUMBER ofwelts
drilled:
9.Total well depth below land siflce: Sit
Pornnepfe welly lift afl depths Ijdroil (amn ple'•i(a)2dd'col201100)
10. Stack water level below top of anion:
Ifweter Ind !tube- caring, use •'+'•
11.Borehole dlameter., la go.)
12. Well eohrtnatioo method: aw... '
se -
(I.e. auger. away, aabte, &met mob, ate.)
MOM
.av "•
Roo
ft
.31r. 14 . Ctrs �~j
1 olMftn __ TnICIaN McTrmaL
ft & m ».Irck4A vt_
R'•6.DIe, Ntl.tdi�lfft;,,,a..�: ,.a: ;,;;'.l'RA;At
ft fa
R fa
ft.
0.
;neva
MOM
tl
1.
TO fNMOalR
3.r 0. / 1%v ter.
0. as
MOM tlOT
0 te, Sod.
ft
N.
n. R
PROM TO
ft R
swam Maass
0/0 lte.l•yd
e'ttmot unmet siteramernoha AMOUNT
loleirti3 etair —rsy
ait flIO .:
j maruceMerNuoerxou
ft .ft
FROM To paeCRWnorateor mane. softwa eatarhe• ea)
a:
0.
ft
m
d.
0.
R
ft
a
e.
et.
RECE v .I
R
ft
MAR a 32ap
1'a: n+lation t rout:shins, Unit
DWQfBOG
22. Cer(gkadou:
Dam
Sfgoaaaee ad Coawae(7 Dais 7/7
this t
b
was (were) censtrvcral in accordance
wwlth1r3A�ACA ON'.oroeNor ISANCAC 02C.af Arad Canova Sondra and that a
coma( this record he been prodded M are well owner.
•
23. Site diagram or additions! well details:
You may um the back of ills page to provide additional well site details or well
eonstruedondeails. Younmyayoattach additional pages ifnecessay.
SUBMITTAL tNSTRUC11ON
24ft For Ail We Submit this tbrm within 30 der s of completion of well
construction to the ftdlowfng:
(Res Dtvtakn ot Water Resoarees, marinade) Proeesang Unit.
1617 Mall Service Center, Raleigh, NC27699-1617
240. For tuiemioa Wallas In addition to sanding the Taco to the address in Ma
above. oleo submit one dopy of this limn withio 30 days of completivr of well
conshaaion to the toilovdog:
Mahlon of Water Resources, Undelgroand inieetiop Ceotrol Program,
1636 Mail Service Center, Raleigh, NC 27699-1636 1n
24c. For Water Samna&Jaiocsloa Walls: la ade ,E11 ti, ii:ODENRJi'D1NR
the addwes(es) shove, also submit one copy of this loom within 30 days of
completion of well construction to the comity health depamnan of the many
whore Mnaon:Md
FOR WATER SUPPLY WELLS ONLY:
Ma Yield Won &
13E. Disinfection type.
Method oftat. pet
Amount:
APR 0 3 2017.
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
gig ty,vJO,Je5
wit Comas&namc
Alta?
NC WclI Contactor enaction Numbs:
jQ. G .IA A.,tltl Det,it a nsi
Company Kama
2. Well Construed:a Permit e:
his all gnpawdle wail trrn#,w ben paMnlr (Le. WC Crnmry, Seas. Paea we me)
3. Well Use (cheek well use):
Water Supply Well:
nAgrialteral f MunicipallPubFo
QCaotMmial (Heating/Cooling Suppty) QResidentd Wear Supply (single)
['Industrial/Commercial ['Residential Wafer Supply (shag)
Wagon
Noa.Wster Supply Well:
QMt"wiing
Jean Wen:
QAquifer Recharge
©Aquifer Stomgeand Recovery
©Aquifer Test
`JErrpaimanal Technology
QGmiheimal (Closed Loop) ()Tram
lOsotbennal (Heachw/Cooiilig Return) f o her (explain under 021 Remulka)
1^ Date Willis) Completed: 3" g ' /'J Well ION
5a. Well Location:
Por Internal Use Only;
44258S
ell WATED.ZONES,..:
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1.
MATERIAL.
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EMMACEMEATMArHOR
MATERIAL
$aLtti.. GAAS
FM:ilitylovmcrName
©iteoovery
DGmuadwater Remediadon
©Salinity Barrier
©SWtmwater Drainage
QSubaideace Control.
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eathetheINGISth
70
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a.
i atomOtt(rrbn taM iseasnoafIotaobelm am)
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k
tt
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2
Peony SDP (t'euplimblc)
�8 I E.e Rk-y p f w,) ,a. fU t
Pbysical Addmx, C y, ad Zip
/a..to NnAro
Canty surd Identification No, (FlK).
5b. Ladtade tad ter blade is dagraar/minntes/saeonds or decimal demean
(ifwell fled, cc latllpog Dsugtetes0
et ° //e ?,73 N 011 ° C9, SI) W
6.le(ae)wewdUOetermanent or ©Temporary
7. Is dill arepatr toaaatistblgwdl: Ores • or ONO _
if MIX Ira mpg', fill out balm wed mssImdlon Infnnari000nduplaN fee tenure of the
wait emir, gal remark aadian a an the 6o*gaie/6rm.
B. For GeoprobeNIFY or Closed -top Geothermal WOO having the same
eonsbutrion,only I GW-I is needed. Indicate TOTAL NUMBER ofwells
drilled:
9. Total well depth blow land surface: tog ((b)
Formutrele wells let alldepdsa 'different (emmpie-30200'and )eleg)
10, Slat wafer fad below top of taker ) G
(%water fowl lr above mtg. We "+"
11.Borebole diameter: ( (1n)
12. Well ten truedeo melbbd: JAx
(LA as, rotery. abio, deem mob. WI
(ft.)
FOR WATER SUPPLY WELLS ONLXt
13n. Ytdd (gpm) �4 Method of test: cto s,f
13b. DteinrvMioa type: Amounts
1t.
a.
R
k.
�J' -6• a!'-! V jj
:W&AR.2w31117.
tflV ' thffon Processing Unit
2E Certilntioat_
Si of
.ens
l*aCMr
0-en
Dun
ayragnMg this fAL,ltl�ieby coretAam, wells) war (wee mAto monad aoonierb,
we, NOIC 02C,0100 or ISANCac orc.0700 wra'Canna:won $a,,,dt m,dmafo
copy oftle record hes been providnitothe wcliowner.
i3, Site diagram or additional w'dl details:
You mg use the back of ibis page te provide additional well site detaib or well
oonmuctan details. You may also attachadditional pasta ifnecessity.
SUBMfi'tAL MaTR=0NE
24a. For All Wei: Submit this tbnn within 30 days of completion of well
croswaion toUatbllow rag:
DlvMoaof Water Resources, information Processing Unit
1617 Mall Service Center, Rddgb, NC 27699-161.7
24b. For fnfeation We: In addition to sanding the farm to the address in 24a
above, also submit one espy of min form when 30 days of completion of well
Gemination to the towing;
Division of Water Ramona, Underground Nation Control Program,
1636 Moil Service Center. Rak%h, NC 27699.1636
24n For Water Stunt & lnketioa WIfi1: la addition to sending the fount to
the address(es) above, also submit one any of this them wtahiO 30 days of
completion of well construction to the county lki@EleiReOVORIOWR
where M1.nd ilvel
APR 0 3 2017
Water Quality Regional
Operations Setion

WELL CONS RUCTIO coj» foes-n
1. Wed Contractor Information:
Gar% San1.S
Well Con et N.ma
a194
NC Well CanasslwCertideation Number
s uv9 WCIA O2 h. as
Company tame 7
2. Wetl Construction Permit Ns
4ts1. ell cloned* well anelnicaon permits (i.e. INC Como. Suva Parianan as 3. well Use (cheek well use):
Water Sup$ Welk
f AgriC4ltural
foeodtennai (Heating/Cooling Supply)
�flltnndusbia)/Contmercial
peu^RAdOn
Non -Water Simply Well:
QMomwdng
Infection Wells
©Aguilar Recharge
©Aquifer Storage and Recovery
[Aquifer Test
a6xperimen d Technology
QGeoshemid (Closed loop)
,kGeothannd (Heating/Cooling Return) Monter (explain under 021 Remake)
4. Date Weg(e) Completed: 2'/r. — in Wdi f»a
6a. Well location;
Sac Pau -lb PC
FecilitylOwner Name
pea Y-p.VWanJ ,rA.t<.
QMunkipd/Public
f Roaidential Water Supply (single)
OResidendal Water Supply (shared)
°Recovery
®Groundwater Remedimton
®Salinity Barrier
QStotmwater Drainage
f Subsidehrce Control
QTmaes
For Internal Use Only:
.1d._WA
44258'
Lava
av
38• k
ft. l R
11O1TfERCASQC1kr'dnitionadad0)l`tRF3,LLV6SOfb... blel
FROM '•
TO DWaeTtR I 'momMAT6mAt:. ..
�, R• .O ft.to Sei. cto1 INNER OR `
(k:,;:
Pgt TO AMMETER M•Trw,g
e •...
d.
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t7vSOW
ft.
PROM 1 TO
ae R air fts
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TMPIACIMOOMMETROD & AMOUNT
Tara
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a.
fMFnACEMENTa nion
1
tame . Wjlaee, _graniw.h% at
tR
eb
a. tt
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Await" 1De (if eppliteble)
Poysltml Adduw, OD, and2lp
Nt Fln.�vr
Corm, Panel tdendnmdon No. (PIN)
Sb..adtade sad longitude la degreesholnutea/aecoodn or decimal degrees.
Orwell field, one Ietlbag le mdgcimi)
34a /4•S/re N ern"54.4)4 w
6. I$sre) the wel(s)>JFermanent or OTemporary
7. fa this a repair to am existing well; ales or DNo
lala Leampak. ftllad mown well analneeion 10nnatia, and explain the twm a tithe
renter water all meat soma. or ends. hedrgldebt Ann,
B. For Geaprobe/DPT or Closed -Loop Geothermal Wdlehaving the same
oonatiuetion, et 1 CW-L is needed. lndimte TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface:
Formula* went lktdldeptthr refithrem (erunple• 4)200' awl2®lpp
10. Static water lewd below top of rndoge /
fwwler 4tw/twelves raft we "}"
11.Boreholediameter:_ G (in.)
12. Well eoafructioa method: **54—k "
04 sagwn relay, eabl*, & ctptmts Mel
(ft )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) :o 0 Method of ow
136. Disinfection typo Amount:
suits
b.
0. n.
a.
11i.'NEaIKa':.?
RECEIVE
MAR 2
3 2017
ti:d.'n sus rocisautp tlita
Oft/BOG
22. Certification-
3`r6
Sc - -04 .. eat tiConmam Date
By
w/K /M NOW 02C 'Mao or MA KW e Mat0 the
l Cwar ennneticn ni SanddaQvm�Me0
.npyq"th4 Mood ha been providedtaita well ewer,
23. Site diagram or additions! wdl details;
You may uac the back of deb page to provide additional well site details or well
consburtlon details. You may also attach additions) pages if necessary.
DUDMITTAL IINSTRUCTION%
2da. Fm jj Wain: Submit this form within 30 days of completion of well
uonsmmdon W the following:
Division atwitter Resobrcee. lofoemdikn pmeasiog Mgt.
L6ItMail Service Center, Raleigh, NC 27699461.7
24b. For infection Weds. in addition to sending the fun to the address in 24a
above, also submit one mpy of this form within 30 days of completion of well
construction to the following:
Division of Water Resoartcs, Uadeigronod Wades Contra Program,
1636 Man Service Center. Raleigh, NC 276994636
tea. /tor Water Satoh & inteeboo Wdl1: In addition to sending Ike rote: to
vile addsess(es) above, also submit o �(phtepl, days a(
comptadon of well constw ins to vita RRqa eekmy
wh en angered
APR 0 3 2017
Water Quality Regional
Operations Section